|
Antiretroviral
Drugs [Weller IVD and Williams IG. BMJ 2001;322:1410]
This is a review adapted from the fifth edition of the book "ABC
of AIDS" (which is not yet published). The specific interest
here is the comparison of the guidelines of the British HIV Association
with the U.S. guidelines. The comparison is listed below along with
a tabulation of the antiretroviral regimens preferred by the British
HIV Association.
|
Recommendations
for Starting Antiretroviral Therapy in Adults
|
|
BHIVA |
U.S.
DHHS |
Symptomatic
|
Treat |
Treat |
|
Asymptomatic
CD4 < 200
CD4 200-350
|
Treat
Considerations-rate of CD4 ,
symptoms, patient's wishes |
Treat
Treatment usually offered
|
| CD4
> 350 |
Defer |
Defer,
consider if VL high |
|
Antiretroviral
Regimens
|
|
Two
NRTIs plus
- Nevirapine
or efavirenz
- Indinavir,
nelfinavir or Fortovase
- Ritonavir
+ saquinavir
|
|
Triple
NRTI regimen: AZT, 3TC + ABC
|
Comment:
There is almost perfect agreement in terms of recommendations for
starting therapy. The only difference is the verbiage in the category
of CD4 cell counts of 200-350. With regard to antiretroviral regimens,
the U.S. guidelines make greater use of ritonavir-enhanced PI regimens.
Similarities seem greater than differences, especially in terms
of the aggressiveness of treatment once the decision has been made
to start.
posted
9/12/2001
|
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