An international panel of experts has updated its guidelines for treating HIV disease, recommending earlier, more aggressive drug therapy to combat the virus that causes AIDS.

The recommendations, published in today’s issue of the Journal of the American Medical Association, are based on new data from clinical trials and studies of drugs now available, and they offer a new guide to caregivers and patients who deal with the ever-changing state-of-the-art in therapies for HIV disease. The recommendations follow previous treatment guidelines from the same experts that were announced at the International AIDS Conference in Vancouver, BC, in July 1996.

The most important changes in recommended treatment are:

• Patients should begin on antiretroviral therapy earlier in the course of their disease than had been suggested last year, with the goal of reducing the viral load (amount of virus in the blood) to below detectable levels.

• The effective monitoring of viral load levels, which is now technically possible in most caregiving settings, is crucial to the management of therapy in AIDS patients and should be continuous throughout treatment.

• Currently, the most effective initial antiretroviral treatment is a three-drug regimen--two nucleoside analogs and one potent protease inhibitor, taken early in the infection and indefinitely thereafter.

• The initial drugs chosen should be carefully selected after collaboration between patient and physician. The physician should recommend a treatment strategy that takes into account the patient's commitment and ability to adhere to a strict drug regimen, which is required for the three-drug treatment to be effective.

The panel was convened by the International AIDS Society-USA, with participation from researchers from 12 universities and institutes, including Paul A. Volberding, MD, UC San Francisco professor of medicine, director of the UCSF AIDS Program at San Francisco General Hospital, and chairman of the board of the International AIDS Society-USA.

"Recent data have demonstrated that HIV-infected individuals are surviving longer and living healthier lives when it is possible to reduce the viral load in their bodies," said Charles Carpenter, MD, chair of the IAS-USA panel and professor of medicine at Brown University School of Medicine. International AIDS Society-USA is a national not-for-profit organization based in San Francisco that provides information and education for physicians involved in HIV/AIDS care.

The JAMA article with the updated guidelines can be found at HIV InSite.

By Alice Trinkl

1st appeared 6/25/97