US guidelines updated.

The Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents is published and updated by the US Department of Health and Human Services (DHHS). The Guidelines Panel is made up of researchers, physicians, community advocates, and other experts who meet regularly

to review the guidelines, incorporate new knowledge, make changes, etc. The latest round of updates happened in July. The most striking change was the removal of a Chinese-menu-style list of HIV medications from which a doctor could choose a main "anchor" drug (a protease inhibitor or non-nuke) and two "background" drugs (usually nukes) for treating a patient. This was replaced with the actual recommendation of preferred regimens. The two preferred regimens were either:

1. Sustiva + Epivir + (Zerit or Viread or Retrovir), or

2. Kaletra + Epivir + (Zerit or Retrovir)

Alternative regimens were also listed under each preferred regimen. This marks a major change in philosophy for the DHHS guidelines, which have undergone other changes over the years such as recommending to wait until 350 T cells or lower to consider HIV treatment and that treatment definitely be started at 200 T cells or lower. (These thresholds were much higher just a few years ago). The 96-page guidelines document offers a great deal of information and is available online at www.aidsinfo.nih.gov/guidelines.

BOTTOM LINE: HIV treatment must be individualized to take into account disease stage, co-infection, gender, age, other health conditions, etc. There is no universally perfect HIV regimen, and each medication has its good and bad points. Just because you are not on a "preferred" regimen does not mean you aren't being treated for HIV effectively. Talk to your healthcare provider about any questions you might have concerning HIV treatment.