New Guidance Addresses Expanded Antiretroviral Treatment, Perinatal ART, and PrEP

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On October 14, 2011, the U.S. Department of Health and Human Services (DHHS) issued updated guidelines for the use of antiretroviral therapy in adults and adolescents.

The European AIDS Clinical Society (EACS) released revised guidelines the same day at the 13th European AIDS Conference in Belgrade.

The American Association for the Study of the Liver (AASLD) this month released new guidelines for the treatment of genotype 1 chronic hepatitis C, including information about boceprevir (Victrelis) and telaprevir (Incivek).

The new version of the DHHS guidelines keeps the threshold for treatment initiation at 500 cells/mm3, but changes the ranking of certain drugs and adds the recently approved NNRTI rilpivirine.

The EACS guidelines are more conservative, generally recommending treatment initiation at a threshold of 350 cells/mm3, although ART is advised below 500 cells/mm3 -- or even sooner -- for several patient groups including pregnant women and people with co-existing conditions such as HIV-associated kidney disease, neurocognitive impairment, and hepatitis B or C.

The EACS guidelines panel went out on a limb and included recommendations for use of the recently approved hepatitis C virus (HCV) direct-acting antiviral agents boceprevir (Victrelis) and telaprevir (Incivek) by HIV/HCV coinfected patients, even though little data for this population has been reported to date (more is expected in the coming weeks).

Since the new drugs are licensed and prescribable, "we cannot leave them out just because of lack of data," EACS Executive Committee member Jürgen Rockstroh said at an accompanying press conference. "If available and if health insurance will cover them, we believe there are benefits."

Finally, the revised AASLD recommendations -- published in the October 2011 issue of Hepatology in advance of the organization's annual Liver Meeting in early November -- include eagerly awaited information about the use of the HCV protease inhibitors boceprevir and telaprevir, as well as general information about direct-acting agents and how they are expected to change hepatitis C therapy.

10/18/11

References

U.S. Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. October 14, 2011.

European AIDS Clinical Society (EACS). Guidelines. Version 6.0. October 2011.

MG Ghany, DR Nelson, DB Strader, et al. An Update on Treatment of Genotype 1 Chronic Hepatitis C Virus Infection: 2011 Practice Guideline by the American Association for the Study of Liver Diseases. Hepatology 54(4):1433-1444 (abstract). October 2011.