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New Guidelines on How to Treat HIV

Recommendations Shoot for 'Home Run' Against HIV Virus
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Less AIDS Monitoring Needed

As before, the guidelines call for initiating antiviral therapy in any person who develops symptoms of AIDS or whose CD4 cell count ---- the number of CD4 T-cells, which is a measure of how much damage HIV's effect on the has done to immune system -- drops below 200 cells/microliter. The lower the CD4 cell count, the more susceptible a person is to infections. It should also be considered, with the decision individualized, for any person without symptoms whose CD4 count is between 200 and 350 cells/microliter.

"But if you read between the lines, we say maybe start earlier" and increase the strength of therapy as the CD4 count drops, Vella says. The researchers point out one study which showed a benefit to starting treatment when CD4 counts were above 350 cells/microliter.

The guidelines continue to recommend starting people newly infected with HIV on a three-drug cocktail of the oldest class of HIV drugs -- called nucleoside reverse transcriptase inhibitors -- combined with either a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. But once treatment starts, "we suggest doing a little less monitoring than was advocated in the past," Vella tells WebMD. "It's getting a little psychotic," with some people coming in every few days to find out if their drugs are suppressing the virus, she says.

The guidelines now suggest that HIV blood levels be checked every four to eight weeks until the virus is undetectable and then only three to four times a year. CD4 counts should be checked along with HIV blood levels.

Roy M. Gulick, director of the HIV Clinical Trial Unit at the New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City, tells WebMD he welcomes the new guidelines.

"Given the amount of information available and the continuing progress being made by the research community, it's really a challenge to keep up with all the innovations," he says. The guidelines streamline the process, "giving a really good sense of the field and helping to move treatment forward," Gulick says.

The guidelines also appear in a special issue of The Journal of the American Medical Association.

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