Guidelines for the use of antiretroviral agents in HIV infections in Taiwan, revised in 2002 by Infectious Diseases Society of the ROC and Taiwan AIDS Society

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Guidelines for the use of antiretroviral agents
in HIV infections in Taiwan, revised in 2002by
Infectious Diseases Society of the ROC and Taiwan
AIDS Society
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Guidelines for the use of antiretroviral agents
in HIV infections

• Significant progress in the field of
  antiretroviral therapy over the past year .
• New drugs approved for clinical use and new
  insights gained in many aspect of therapy.
• An update of the first Guidelines for the use of
  antiretroviral agents in HIV infections in
  Taiwan established in March 11, 2001, and
  organized a meeting on November 24, 2001.

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Guidelines for the use of antiretroviral agents
in HIV infections

• The new guidelines more conservative in the
• initiation of treatment in asymptomatic patients,
  and
• offered an option for treatment in patients with
• CD4 T cells gt350/mm3

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Guidelines for the use of antiretroviral agents
in HIV infections

• Other important issues not included in this
  guidelines
• the side effects, drug resistance, patients
  compliance,
• prevention of opportunistic infections,
• Immunotherapy, and vaccine.

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Guidelines for the use of antiretroviral agents
in HIV-infected patients

• A. General consideration
• 1.When to start
• (1) Acute HIV infection treatment
  should be offered.
• (2) Symptomatic treatment should be
  offered.
• (3) Asymptomatic

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• Adult
• Treatment should be offered
• CD4 T cells lt350/mm3, or
• HIV RNA gt30,000 copies/ml (bDNA), or
• HIV RNA gt55,000copies/ml (RT-PCR).
• Treatment may be deferred
• CD4 T cells gt350/mm3, or
• HIV RNA lt30,000 copies/ml (bDNA), or
• HIV RNA lt55,000copies/ml (RT-PCR).

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• Pediatrics
• Treatment should be offered to all newly
• diagnosed infected children, if universal early
• treatment not feasible, treatment should be
• offered if there is evidence of immune
• suppression as followings

CD4 T cells
Ages No./mm3
1-5 yrs lt1000 lt25
6-12 yrs lt500 lt25
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• 2.When to change
• (1)Virologic failure
• a. A reduction in plasma HIV RNA of less
  than
• 0.5 to 0.7 log10 4 weeks following
  initiation of
• therapy or less than 1 log10 by
  week 8.
• b. Failure to suppress plasma HIV RNA to
  
• undetectable levels within 4 -6
  months after
• initiation of therapy.

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• c. Repeated detection of virus in plasma after
  initial
• suppression to undetectable level,
  suggesting the
• development of resistance.
• d. Any reproducible significant increase,
  defined as
• 3-fold or greater, from the nadir of plasma
  HIV
• RNA not attributable to intercurrent
  infection,
• vaccination, or test methodology.
• (2) Toxicity
• (3) Intolerance

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• 
  B. Recommended regimensa
• 1.Acute HIV infection
• 
  Drug of choice
  Alternative
• A B
  A B
• Indinavir Combivirb
  Abacavir AZT3TC
• Saquinavir d4T3TC
  AZTddI
• Ritonavir ddI3TC
  
  AZTddc
• Nelfinavir
  
  d4TddI
• Efavirenz
• Nevirapine
• SaquinavirRitonavir
• IndinavirRitonavir
• Kaletrac

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• 2.Asymptomatic HIV infection
• Drug of choice
  Alternative
• A B
  A B
• Indinavir Combivirb
  Abacavir AZT3TC
• Saquinavir d4T3TC
  AZTddI
  
• Ritonavir ddI3TC
  AZTddc
  
• Nelfinavir
  d4TddI
• Efavirenz
• Nevirapine
• SaquinavirRitonavir
• IndinavirRitonavir
• Kaletrac

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• 3.Advanced HIV infection
• Drug of choice
  Alternative
• A B
  A B
• Indinavir Combivirb
  Abacavir AZT3TC
• Saquinavir d4T3TC
  Nevirapine AZTddI
• Ritonavir ddI3TC
  AZTddc
  
• Nelfinavir
  d4TddI
• Efavirenz
• Nevirapine
• SaquinavirRitonavir
• IndinavirRitonavir
• Kaletrac

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• 4.HIV-infected pediatric patientsd
• Drug of choice
  Alternative
• A B
  A B
• Ritonavire AZTg3TCe
  Abacavire AZTgddCe
• Nelfinavirf AZTgddIf
  Nevirapinef d4Te3TCe
• 
  
  d4TeddIf
  
  

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• 5.HIV infection in pregnant women
• Drug of choice
  Alternative
• A B
  A B
• Nevirapine Combivir
  Nelfinavir AZT3TC
• Saquinavir AZTddI
  Indinavir d4T3TC
• Ritonavir
  

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• 6.Prophylaxis after occupational exposureh
  
• Drug of choice
  Alternative
• A B
  A B
• Indinavir Combivir
  Nelfinavir AZT3TC
• 
  Saquinavir d4T3TC

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• Abbreviations
• d4T Stavudine
• 3TC Lamivudine
• AZT Zidovudine
• ddI didanosine
• ddC Zalcitabine
• aAntiretroviral drug regimens are comprised of
• one choice from column A and B.
• bCombivir AZT3TC.
• cKaletra lopinavir/ritonavir.

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• dAll regimens used for adults are also
• recommended for pediatrics.
• eOral solution formulation available.
• fPowder formulation for suspension available.

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Guidelines for the Use of Antiretroviral Agents
in HIV-1 infected in Adults and
Adolescents October 29,
2004

• Developed by the Panel on Clinical Practices for
• Treatment of HIV infection convened by the
• Department of Health and Human Services
  
• (DHHS)

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• It is emphasized that concepts relevant
  to HIV
• management evolve rapidly. The panel
  has a
• mechanism to update recommendations on
  a
• regular basis, and the most recent
  information is
• available on the AIDSinfo Web site.
• (http/AIDSinfo.nih.gov).

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When to treat Indication for antiretroviral
therapyPanels Recommendations

• Antiretroviral therapy is recommended for all
• patients with history of an AIDS-defining
• illness or severe symptoms of HIV infection
• regardless of CD4 T cells count.
• Antiretroviral therapy is also recommended for
• asymptomatic patients with CD4 T cells
• lt 200/mm3.

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• Asymptomatic patients with CD4 T cells
  
• counts of 201- 350/mm3 should be offered
• treatment.
• Asymptomatic patients with CD4 T cells
• counts of gt350/mm3 and plasma HIV
• RNAgt100,000 copies/ml, most experienced
• clinicians defer therapy but some clinician
  
• consider initiating treatment.

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• Therapy should be deferred for patients with
  CD4 T cells counts of gt350/mm3 and plasma HIV
  RNAlt100,000 copies/ml.