This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (600)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • HIV/AIDS  • Women's Health  • Pregnancy and Breast Feeding  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Updated Recommendations of the International AIDS Society–USA Panel

Charles C. J. Carpenter, MD; Margaret A. Fischl, MD; Scott M. Hammer, MD; Martin S. Hirsch, MD; Donna M. Jacobsen; David A. Katzenstein, MD; Julio S. G. Montaner, MD; Douglas D. Richman, MD; Michael S. Saag, MD; Robert T. Schooley, MD; Melanie A. Thompson, MD; Stefano Vella, MD; Patrick G. Yeni, MD; Paul A. Volberding, MD

JAMA. 1998;280:78-86.

Objective.— To provide recommendations for antiretroviral therapy based on information available in mid-1998.

Participants.— An international panel of physicians with expertise in antiretroviral research and care of patients with human immunodeficiency virus (HIV) infection, first convened by the International AIDS Society–USA in December 1995.

Evidence.  —The panel reviewed available clinical and basic science study results (including phase 3 controlled trials; clinical, virologic, and immunologic end point data; data presented at research conferences; and studies of HIV pathophysiology); opinions of panel members were also considered. Recommendations were limited to drugs available in mid-1998.

Consensus Process.  —Panel members monitor new clinical research reports and interim results. The full panel meets regularly to discuss how the new information may change treatment recommendations. Updated recommendations are developed through consensus of the entire panel at each stage of development.

Conclusions.  —Accumulating data from clinical and pathogenesis studies continue to support early institution of potent antiretroviral therapy in patients with HIV infection. A variety of combination regimens show potency, expanding choices for initial regimens for individual patients. Plasma HIV RNA assays with increased sensitivity are important in monitoring therapeutic response; however, more data are needed to determine precisely the HIV RNA levels that define treatment failure. Long-term adverse drug effects are beginning to emerge, requiring ongoing attention. Some issues regarding optimal long-term approaches to antiretroviral management are unresolved. The increased complexity in HIV management requires ongoing monitoring of new data for optimal treatment of HIV infection.

From Brown University School of Medicine, Providence, RI (Dr Carpenter); University of Miami School of Medicine, Miami, Fla (Dr Fischl); Harvard Medical School, Boston, Mass (Drs Hammer and Hirsch); the International AIDS Society–USA, San Francisco, Calif (Ms Jacobsen); Stanford University Medical Center, Stanford, Calif (Dr Katzenstein); St Paul's Hospital, Vancouver, British Columbia (Dr Montaner); University of California, San Diego, and San Diego Veterans Affairs Medical Center (Dr Richman); University of Alabama at Birmingham (Dr Saag); University of Colorado School of Medicine, Denver (Dr Schooley); AIDS Research Consortium of Atlanta, Atlanta, Ga (Dr Thompson); Istituto Superiore di Sanità, Rome, Italy (Dr Vella); Hôpital Bichat-Claude Bernard, X. Bichat Medical School, Paris, France (Dr Yeni); and University of California, San Francisco (Dr Volberding).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association Between HIV-1 RNA Level and CD4 Cell Count Among Untreated HIV-Infected Individuals
Lima et al.
AJPH 2009;99:S193-S196.
ABSTRACT | FULL TEXT  

Trends in the prescription of antiretroviral drugs and impact on plasma HIV-RNA measurements
Jimenez-Nacher et al.
J Antimicrob Chemother 2008;62:816-822.
ABSTRACT | FULL TEXT  

Immunological Responses and Long-Term Treatment Interruption after Human Immunodeficiency Virus Type 1 (HIV-1) Lipopeptide Immunization of HIV-1-Infected Patients: the LIPTHERA Study
Pialoux et al.
CVI 2008;15:562-568.
ABSTRACT | FULL TEXT  

Possible Therapeutic Vaccine Strategy against Human Immunodeficiency Virus Escape from Reverse Transcriptase Inhibitors Studied in HLA-A2 Transgenic Mice
Okazaki et al.
J. Virol. 2006;80:10645-10651.
ABSTRACT | FULL TEXT  

Structural Basis for the Interaction of CCR5 with a Small Molecule, Functionally Selective CCR5 Agonist.
Saita et al.
J. Immunol. 2006;177:3116-3122.
ABSTRACT | FULL TEXT  

The feasibility of clinical endpoint trials in HIV infection in the highly active antiretroviral treatment (HAART) era
Mocroft et al.
Clin Trials 2006;3:119-132.
ABSTRACT  

Changes over time in risk of initial virological failure of combination antiretroviral therapy: a multicohort analysis, 1996 to 2002.
Lampe et al.
Arch Intern Med 2006;166:521-528.
ABSTRACT | FULL TEXT  

Outcome of Critically Ill Human Immunodeficiency Virus-Infected Patients in the Era of Highly Active Antiretroviral Therapy
Khouli et al.
J Intensive Care Med 2005;20:279-285.
ABSTRACT  

Eosinophilic Folliculitis: Before and After the Introduction of Antiretroviral Therapy
Rajendran et al.
Arch Dermatol 2005;141:1227-1231.
ABSTRACT | FULL TEXT  

Highly Potent Inhibition of Human Immunodeficiency Virus Type 1 Replication by TAK-220, an Orally Bioavailable Small-Molecule CCR5 Antagonist
Takashima et al.
Antimicrob. Agents Chemother. 2005;49:3474-3482.
ABSTRACT | FULL TEXT  

Clinical Trials in Sub-Saharan Africa and Established Standards of Care: A Systematic Review of HIV, Tuberculosis, and Malaria Trials
Kent et al.
JAMA 2004;292:237-242.
ABSTRACT | FULL TEXT  

Experiences of Contemplating Returning to Work for People Living with HIV/AIDS
Nixon and Renwick
Qual Health Res 2003;13:1272-1290.
ABSTRACT  

Prognostic Factors for Survival in Human Immunodeficiency Virus-associated Pulmonary Arterial Hypertension
Nunes et al.
Am. J. Respir. Crit. Care Med. 2003;167:1433-1439.
ABSTRACT | FULL TEXT  

Marked Dyslipidemia in Human Immunodeficiency Virus-Infected Children on Protease Inhibitor-Containing Antiretroviral Therapy
Lainka et al.
Pediatrics 2002;110:e56-56.
ABSTRACT | FULL TEXT  

Human Immunodeficiency Virus Type 1 Genotypic and Pharmacokinetic Determinants of the Virological Response to Lopinavir-Ritonavir-Containing Therapy in Protease Inhibitor-Experienced Patients
Masquelier et al.
Antimicrob. Agents Chemother. 2002;46:2926-2932.
ABSTRACT | FULL TEXT  

Intensive Care of Human Immunodeficiency Virus-infected Patients during the Era of Highly Active Antiretroviral Therapy
Morris et al.
Am. J. Respir. Crit. Care Med. 2002;166:262-267.
ABSTRACT | FULL TEXT  

Unrecognized HIV Infection Among Patients Attending Sexually Transmitted Disease Clinics
Weinstock et al.
AJPH 2002;92:280-283.
ABSTRACT | FULL TEXT  

Pharmacokinetic Interactions between Nelfinavir and 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors Atorvastatin and Simvastatin
Hsyu et al.
Antimicrob. Agents Chemother. 2001;45:3445-3450.
ABSTRACT | FULL TEXT  

Infection with GB Virus C and Reduced Mortality among HIV-Infected Patients
Tillmann et al.
NEJM 2001;345:715-724.
ABSTRACT | FULL TEXT  

Nelfinavir, Efavirenz, or Both after the Failure of Nucleoside Treatment of HIV Infection
Albrecht et al.
NEJM 2001;345:398-407.
ABSTRACT | FULL TEXT  

Mast cells/basophils in the peripheral blood of allergic individuals who are HIV-1 susceptible due to their surface expression of CD4 and the chemokine receptors CCR3, CCR5, and CXCR4
Li et al.
Blood 2001;97:3484-3490.
ABSTRACT | FULL TEXT  

Respiratory diseases in pregnancy {bullet} 2: Pneumonia and pregnancy
Lim et al.
Thorax 2001;56:398-405.
FULL TEXT  

Circulating Metabolites of the Human Immunodeficiency Virus Protease Inhibitor Nelfinavir in Humans: Structural Identification, Levels in Plasma, and Antiviral Activities
Zhang et al.
Antimicrob. Agents Chemother. 2001;45:1086-1093.
ABSTRACT | FULL TEXT  

Statistical advances in AIDS therapy trials
Albert and Yun
Stat Methods Med Res 2001;10:85-100.
ABSTRACT  

HIV Resistance Testing in Clinical Practice: A QALY-fied Success
Saag
ANN INTERN MED 2001;134:475-477.
FULL TEXT  

Effect of Errors in the Sequence of Optical Densities from the Roche AMPLICOR HIV-1 MONITOR Assay on the Validity of Assay Results
Brambilla et al.
J. Clin. Microbiol. 2001;39:1118-1120.
ABSTRACT | FULL TEXT  

Sources Influencing Patients in Their HIV Medication Decisions
Meredith et al.
Health Educ Behav 2001;28:40-50.
ABSTRACT  

Factors Influencing Physicians' Judgments of Adherence and Treatment Decisions for Patients with HIV Disease
Bogart et al.
Med Decis Making 2001;21:28-36.
ABSTRACT  

Acquired Immunodeficiency Syndrome-Related Kaposi's Sarcoma Regression After Highly Active Antiretroviral Therapy: Biologic Correlates of Clinical Outcome
Cattelan et al.
J Natl Cancer Inst Monogr 2000;2000:44-49.
ABSTRACT | FULL TEXT  

Simultaneous Quantitation of Intracellular Zidovudine and Lamivudine Triphosphates in Human Immunodeficiency Virus-Infected Individuals
Rodriguez et al.
Antimicrob. Agents Chemother. 2000;44:3097-3100.
ABSTRACT | FULL TEXT  

Quality of Human Immunodeficiency Virus Viral Load Testing in Australia
Best et al.
J. Clin. Microbiol. 2000;38:4015-4020.
ABSTRACT | FULL TEXT  

Infections in AIDS: Proceedings of the Sixth Liverpool Tropical School Bayer Symposium on Microbial Diseases held on 6 February 1999
HART et al.
J Med Microbiol 2000;49:947-967.
FULL TEXT  

Mutants of Human Immunodeficiency Virus Type 1 (HIV-1) Reverse Transcriptase Resistant to Nonnucleoside Reverse Transcriptase Inhibitors Demonstrate Altered Rates of RNase H Cleavage That Correlate with HIV-1 Replication Fitness in Cell Culture
Archer et al.
J. Virol. 2000;74:8390-8401.
ABSTRACT | FULL TEXT  

A Double-Blind, Adjuvant-Controlled Trial of Human Immunodeficiency Virus Type 1 (HIV-1) Immunogen (Remune) Monotherapy in Asymptomatic, HIV-1-Infected Thai Subjects with CD4-Cell Counts of >300
Churdboonchart et al.
CVI 2000;7:728-733.
ABSTRACT | FULL TEXT  

Comparative Evaluation of Three Human Immunodeficiency Virus Genotyping Systems: the HIV-GenotypR Method, the HIV PRT GeneChip Assay, and the HIV-1 RT Line Probe Assay
Wilson et al.
J. Clin. Microbiol. 2000;38:3022-3028.
ABSTRACT | FULL TEXT  

Risk and Management of Blood-Borne Infections in Health Care Workers
Beltrami et al.
Clin. Microbiol. Rev. 2000;13:385-407.
ABSTRACT | FULL TEXT  

Psychosocial Issues in the Era of New AIDS Treatments from the Perspective of Persons Living with HIV
Bogart et al.
J Health Psychol 2000;5:500-516.
ABSTRACT  

Antiretroviral Drug Resistance Testing in Adult HIV-1 Infection: Recommendations of an International AIDS Society-USA Panel
Hirsch et al.
JAMA 2000;283:2417-2426.
ABSTRACT | FULL TEXT  

A Mutation in Human Immunodeficiency Virus Type 1 Protease, N88S, That Causes In Vitro Hypersensitivity to Amprenavir
Ziermann et al.
J. Virol. 2000;74:4414-4419.
ABSTRACT | FULL TEXT  

Psychological Effects of HAART: A 2-Year Study
Rabkin et al.
Psychosom. Med. 2000;62:413-422.
ABSTRACT | FULL TEXT  

Effect of Antiretroviral Therapy on Viral Load, CD4 Cell Count, and Progression to Acquired Immunodeficiency Syndrome in a Community Human Immunodeficiency Virus-Infected Cohort
Erb et al.
Arch Intern Med 2000;160:1134-1140.
ABSTRACT | FULL TEXT  

Monitoring patients with HIV disease
Helbert and Breuer
J. Clin. Pathol. 2000;53:266-272.
FULL TEXT  

Antiviral Activity of 2'-Deoxy-3'-Oxa-4'-Thiocytidine (BCH-10652) against Lamivudine-Resistant Human Immunodeficiency Virus Type 1 in SCID-hu Thy/Liv Mice
Stoddart et al.
Antimicrob. Agents Chemother. 2000;44:783-786.
ABSTRACT | FULL TEXT  

Clinical pharmacokinetics of nelfinavir combined with efavirenz and stavudine during rescue treatment of heavily pretreated HIV-infected patients
Regazzi et al.
J Antimicrob Chemother 2000;45:343-347.
ABSTRACT | FULL TEXT  

Quantitative and Cost Comparison of Ultrasensitive Human Immunodeficiency Virus Type 1 RNA Viral Load Assays: Bayer bDNA Quantiplex Versions 3.0 and 2.0 and Roche PCR Amplicor Monitor Version 1.5
Elbeik et al.
J. Clin. Microbiol. 2000;38:1113-1120.
ABSTRACT | FULL TEXT  

Antiretroviral Therapy during Primary Immunodeficiency Virus Infection Can Induce Persistent Suppression of Virus Load and Protection from Heterologous Challenge in Rhesus Macaques
Rosenwirth et al.
J. Virol. 2000;74:1704-1711.
ABSTRACT | FULL TEXT  

The Case for More Cautious, Patient-Focused Antiretroviral Therapy
Henry
ANN INTERN MED 2000;132:306-311.
ABSTRACT | FULL TEXT  

Substitution of protease inhibitors during treatment of patients with human immunodeficiency virus infection: frequency, mode, reasons and mid-term outcome
Manfredi and Chiodo
J Antimicrob Chemother 2000;45:261-263.
FULL TEXT  

Effects of recombinant ovine interferon-{tau} on ovine lentivirus replication and progression of disease
Juste et al.
J. Gen. Virol. 2000;81:525-532.
ABSTRACT | FULL TEXT  

Antiretroviral Therapy in Adults: Updated Recommendations of the International AIDS Society-USA Panel
Carpenter et al.
JAMA 2000;283:381-390.
ABSTRACT | FULL TEXT  

Drug Susceptibility in HIV Infection After Viral Rebound in Patients Receiving Indinavir-Containing Regimens
Havlir et al.
JAMA 2000;283:229-234.
ABSTRACT | FULL TEXT  

Evaluation of the Quantiplex Human Immunodeficiency Virus Type 1 RNA 3.0 Assay in a Tertiary-Care Center
Gale
CVI 2000;7:122-124.
ABSTRACT | FULL TEXT  

Efficacy and Safety of Adefovir Dipivoxil With Antiretroviral Therapy: A Randomized Controlled Trial
Kahn et al.
JAMA 1999;282:2305-2312.
ABSTRACT | FULL TEXT  

AIDS-Related Opportunistic Illnesses Occurring After Initiation of Potent Antiretroviral Therapy: The Swiss HIV Cohort Study
Ledergerber et al.
JAMA 1999;282:2220-2226.
ABSTRACT | FULL TEXT  

HIV-1 Genotypic Resistance Patterns Predict Response to saquinavir-ritonavir Therapy in Patients in Whom Previous Protease Inhibitor Therapy Had Failed
Zolopa et al.
ANN INTERN MED 1999;131:813-821.
ABSTRACT | FULL TEXT  

Toxicity, Biological Activity, and Pharmacokinetics of TXU (Anti-CD7)-Pokeweed Antiviral Protein in Chimpanzees and Adult Patients Infected with Human Immunodeficiency Virus
Uckun et al.
J. Pharmacol. Exp. Ther. 1999;291:1301-1307.
ABSTRACT | FULL TEXT  

Kinetics of Antiviral Activity and Intracellular Pharmacokinetics of Human Immunodeficiency Virus Type 1 Protease Inhibitors in Tissue Culture
Nascimbeni et al.
Antimicrob. Agents Chemother. 1999;43:2629-2634.
ABSTRACT | FULL TEXT  

Inhibition of Human Immunodeficiency Virus Type 1 Replication in Acutely and Chronically Infected Cells by EM2487, a Novel Substance Produced by a Streptomyces Species
Baba et al.
Antimicrob. Agents Chemother. 1999;43:2350-2355.
ABSTRACT | FULL TEXT  

Survival of a human immunodeficiency patient with nucleoside-induced lactic acidosis—role of haemodialysis treatment
Chodock et al.
Nephrol Dial Transplant 1999;14:2484-2486.
FULL TEXT  

Think HIV: Why Physicians Should Lower Their Threshold for HIV Testing
Freedberg and Samet
Arch Intern Med 1999;159:1994-2000.
FULL TEXT  

HIV-1 Drug Resistance in Newly Infected Individuals
Boden et al.
JAMA 1999;282:1135-1141.
ABSTRACT | FULL TEXT  

Reduced Antiretroviral Drug Susceptibility Among Patients With Primary HIV Infection
Little et al.
JAMA 1999;282:1142-1149.
ABSTRACT | FULL TEXT  

Human Immunodeficiency Virus 1 Protease Inhibitors in Clinical Practice: Predictors of Virological Outcome
Valdez et al.
Arch Intern Med 1999;159:1771-1776.
ABSTRACT | FULL TEXT  

Optimizing Care for Persons with HIV Infection
Hecht et al.
ANN INTERN MED 1999;131:136-143.
ABSTRACT | FULL TEXT  

Safety and Pharmacokinetics of Amprenavir (141W94), a Human Immunodeficiency Virus (HIV) Type 1 Protease Inhibitor, following Oral Administration of Single Doses to HIV-Infected Adults
Sadler et al.
Antimicrob. Agents Chemother. 1999;43:1686-1692.
ABSTRACT | FULL TEXT  

The P236L Delavirdine-Resistant Human Immunodeficiency Virus Type 1 Mutant Is Replication Defective and Demonstrates Alterations in both RNA 5'-End- and DNA 3'-End-Directed RNase H Activities
Gerondelis et al.
J. Virol. 1999;73:5803-5813.
ABSTRACT | FULL TEXT  

Randomized trial of the platelet-activating factor antagonist lexipafant in HIV-associated cognitive impairment
Schifitto et al.
Neurology 1999;53:391-391.
ABSTRACT | FULL TEXT  

Sarcoid-like Pulmonary Disorder in Human Immunodeficiency Virus-infected Patients Receiving Antiretroviral Therapy
NACCACHE et al.
Am. J. Respir. Crit. Care Med. 1999;159:2009-2013.
ABSTRACT | FULL TEXT  

Prophylactic Cesarean Delivery for the Prevention of Perinatal Human Immunodeficiency Virus Transmission: The Case for Restraint
Stringer et al.
JAMA 1999;281:1946-1949.
FULL TEXT  

Induction/Maintenance Treatment Regimens for HIV
Montaner
JAMA 1999;281:1680-1682.
FULL TEXT  

A small-molecule, nonpeptide CCR5 antagonist with highly potent and selective anti-HIV-1 activity
Baba et al.
Proc. Natl. Acad. Sci. USA 1999;96:5698-5703.
ABSTRACT | FULL TEXT  

Comparison of the Frequencies and Levels of Human Immunodeficiency Virus Type 1 Markers in Specimens from Chronically Infected Human T-Lymphocyte Cultures and from Patients
Witt et al.
CVI 1999;6:369-376.
ABSTRACT | FULL TEXT  

Switching HIV-1 Protease Inhibitor Therapy: Which? When? And Why?
Guardiola et al.
Arch Intern Med 1999;159:194-195.
FULL TEXT  

The Costs, Clinical Benefits, and Cost-Effectiveness of Screening for Cervical Cancer in HIV-Infected Women
Goldie et al.
ANN INTERN MED 1999;130:97-107.
ABSTRACT | FULL TEXT  

Misdiagnosis of HIV Infection by HIV-1 Plasma Viral Load Testing: A Case Series
Rich et al.
ANN INTERN MED 1999;130:37-39.
ABSTRACT | FULL TEXT  

Characteristics of Primary HIV Infection
Corey and Schacker
ANN INTERN MED 1999;130:80-81.
FULL TEXT  

The Care of HIV-Infected Adults in the United States
Bozzette et al.
NEJM 1998;339:1897-1904.
ABSTRACT | FULL TEXT  

Therapeutic Strategies for HIV Infection -- Time to Think Hard
Cooper and Emery
NEJM 1998;339:1319-1321.
FULL TEXT  

A Standard of HIV Care for Incarcerated Women: Northeastern United States' Experiences
De Groot et al.
J Correct Health Care 1998;5:139-177.
ABSTRACT  

Treating AIDS in 1998
JWatch General 1998;1998:1-1.
FULL TEXT