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Updated Recommendations of the International AIDS Society-USA Panel

Patrick G. Yeni, MD; Scott M. Hammer, MD; Charles C. J. Carpenter, MD; David A. Cooper, MD, DSc; Margaret A. Fischl, MD; Jose M. Gatell, MD, PhD; Brian G. Gazzard, MA, MD; Martin S. Hirsch, MD; Donna M. Jacobsen, BS; David A. Katzenstein, MD; Julio S. G. Montaner, MD; Douglas D. Richman, MD; Michael S. Saag, MD; Mauro Schechter, MD, PhD; Robert T. Schooley, MD; Melanie A. Thompson, MD; Stefano Vella, MD; Paul A. Volberding, MD

JAMA. 2002;288:222-235.

Objective  New information warrants updated recommendations for the 4 central issues in antiretroviral therapy: when to start, what drugs to start with, when to change, and what to change to. These updated recommendations are intended to guide practicing physicians actively involved in human immunodeficiency virus (HIV)– and acquired immunodeficiency syndrome (AIDS)–related care.

Participants  In 1995, physicians with specific expertise in HIV-related basic science and clinical research, antiretroviral therapy, and HIV patient care were invited by the International AIDS Society-USA to serve on a volunteer panel. In 1999, others were invited to broaden international representation. The 17-member panel met regularly in closed meetings between its last report in 2000 and April 2002 to review current data. The effort was sponsored and funded by the International AIDS Society-USA, a not-for-profit physician education organization.

Evidence and Consensus Process  The full panel was convened in late 2000 and assigned 7 section committees. A section writer and 3 to 5 section committee members (each panel member served on numerous sections) identified relevant evidence and prepared draft recommendations. Basic science, clinical research, and epidemiologic data from the published literature and abstracts from recent (within 2 years) scientific conferences were considered by strength of evidence. Extrapolations from basic science data and expert opinion of the panel members were included as evidence. Draft sections were combined and circulated to the entire panel and discussed in a series of full-panel conference calls until consensus was reached. Final recommendations represent full consensus agreement of the panel.

Conclusions  Because of increased awareness of the activity and toxicity of current drugs, the threshold for initiation of therapy has shifted to a later time in the course of HIV disease. However, the optimal time to initiate therapy remains imprecisely defined. Availability of new drugs has broadened options for therapy initiation and management of treatment failure, which remains a difficult challenge.

Author Affiliations: Hôpital Bichat-Claude Bernard, X. Bichat Medical School, Paris, France (Dr Yeni); Columbia University College of Physicians and Surgeons, New York, NY (Dr Hammer); Brown University School of Medicine, Providence, RI (Dr Carpenter); University of New South Wales, Sydney, Australia (Dr Cooper); University of Miami School of Medicine, Miami, Fla (Dr Fischl); Hospital Clinic, University of Barcelona, Barcelona, Spain (Dr Gatell); Chelsea and Westminster Hospital, London, England (Dr Gazzard); Harvard Medical School, Boston, Mass (Dr Hirsch); The International AIDS Society-USA (Ms Jacobsen); Stanford University Medical Center, Stanford, Calif (Dr Katzenstein); University of British Columbia, Canada (Dr Montaner); University of California San Diego and San Diego VA Healthcare System (Dr Richman); The University of Alabama at Birmingham (Dr Saag); Universidade Federal do Rio de Janeiro, Brasil (Dr Schechter); University of Colorado School of Medicine, Denver (Dr Schooley); AIDS Research Consortium of Atlanta, Georgia (Dr Thompson); Istituto Superiore di Sanità, Rome, Italy (Dr Vella); University of California San Francisco and San Francisco Veterans Affairs Medical Center (Dr Volberding).

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