Antiretroviral Therapy in Adults
Updated Recommendations of the International AIDS Society–USA Panel
- Charles C. J. Carpenter, MD;
- David A. Cooper, MD, DSc;
- Margaret A. Fischl, MD;
- Jose M. Gatell, MD, PhD;
- Brian G. Gazzard, MA, MD;
- Scott M. Hammer, 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;
- Patrick G. Yeni, MD;
- Paul A. Volberding, MD
- Author Affiliations: 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); University of Barcelona, Barcelona, Spain (Dr Gatell); Chelsea and Westminster Hospital, London, England (Dr Gazzard); Columbia University College of Physicians and Surgeons, New York, NY (Dr Hammer); Harvard Medical School, Boston, Mass (Dr 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); Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (Dr Schechter); 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).
Abstract
Objective To update recommendations for antiretroviral therapy for adult human immunodeficiency virus type 1 (HIV-1) infection, based on new information and drugs that are available.
Participants A 17-member international physician panel with antiretroviral research and HIV patient care experience initially convened by the International AIDS Society–USA in December 1995.
Evidence Available clinical and basic science data including phase 3 controlled trials; data on clinical, virologic, and immunologic end points; research conference reports; HIV pathogenesis data; and panel expert opinion. Recommendations were limited to therapies available (US Food and Drug Administration approved) in 1999.
Consensus Process The panel assesses new research reports and interim results and regularly meets to consider how the new data affect therapy recommendations. Recommendations are updated via full-panel consensus. Guidelines are presented as recommendations if the supporting evidence warrants routine use in the particular situation and as considerations if data are preliminary or incomplete but suggestive.
Conclusions The availability of new antiretroviral drugs has expanded treatment choices. The importance of adherence, emerging long-term complications of therapy, recognition and management of antiretroviral failure, and new monitoring tools are addressed. Optimal care requires individualized management and ongoing attention to relevant scientific and clinical information in the field.
