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Guidelines on Starting Antiretroviral Therapy

Updated HIV treatment guidelines issued by the US Department of Health and Human Services (DHHS) in October 2011 recommend initiation of antiretroviral therapy for HIV-infected patients who belong to the following categories: [ DHHS Guidelines]

Have a history of an AIDS-defining illness or a CD4+cell count < 350 cells/mm3
Have CD4+ cell count of 350 to 500 cells/mm3
Any CD4+ cell count plus any of the following
conditions: HIV-associated nephropathy or hepatitis B virus (HBV) coinfection that requires treatment
Pregnant women who do not otherwise meet the criteria for treatment, with the goal of preventing perinatal transmission
Have CD4+ cell count > 500 cells/mm3 (However, 50% of the members of the panel that developed the guidelines regard treatment at this level as optional)

Patients in any of these categories should be willing and able to commit to lifelong treatment and should understand the benefits and risks of therapy and the importance of adherence, and clinicians may recommend delaying the start of therapy based on a patient’s clinical and/or psychosocial factors. [DHHS Guidelines]

Another benchmark set of HIV treatment guidelines, from the 2010 International AIDS Society (IAS)-USA, recommends that HAART should be started in all patients with CD4+ cell counts ≤ 500 cells/mm3 and should be considered in patients with CD4+ cell counts > 500 cells/mm3.[Thompson 2010] The IAS-USA guidelines also recommend initiating treatment for the following categories of HIV patients:

Those with symptomatic HIV disease
All pregnant women
Those having HIV-1 RNA > 100,000 copies/mL
Those experiencing rapid CD4+ cell count decline (> 100 cells/mm3/per year)
Those with

Active HBV or hepatitis C virus (HCV) coinfection
Current or at high risk for cardiovascular disease
HIV-associated nephropathy
Symptomatic acute HIV infection

Those at high risk for secondary HIV transmission—eg, serodiscordant couples
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	3. Promoting HIV Testing in Diverse Populations Curricula 1 2 3 4 AETC-NMC Home Curricula Home Glossary Feedback

	About Curriculum 3 Module 1: U.S. HIV Epidemiology Learning Objectives & Pretraining Assessment The HIV Epidemic in the United States The HIV Epidemic, cont. By Risk Group Key Events in the US HIV Epidemic (early 1980s - late 1990s) (2000 - present) African American Populations Hispanic/Latino Populations MSM Populations Asian and Pacific Islander Populations American Indian/Native Alaska Populations Summary References Assessment Questions Module 2: Recommendations for Routine HIV Testing Learning Objectives & Pretraining Assessment Development of HIV Screening Recommendations Rationale Underlying the 2006 Recommendations Revised Recommendations for HIV Testing Summary References Assessment Questions Module 3: Benefits of Early Testing and Risks of Delayed Testing Learning Objectives & Pretraining Assessment Timing of Initiation of HAART Guidelines on Starting Antiretroviral Therapy Benefits Associated With Early Therapy Initiation Diagnosis in the ED Risks of Delayed HIV Diagnosis and Treatment Summary References Assessment Questions Module 4: Barriers to Testing and Strategies to Improve Rates of Routine HIV Testing Learning Objectives & Pretraining Assessment Discovering Barriers to Wider Use of HIV Screening Provider-Related Barriers Impact of State and Local Laws and Regulations Population-Specific Barriers Factors That Impede HIV Testing Among Latinos Factors That Impede HIV Testing Among American Indians/Alaska Natives Factors That Impede HIV Testing Among Asian/Pacific Islanders Strategies to Improve Routine HIV Testing Working With Community Organizations Summary References Assessment Questions Module 5: HIV Testing Technologies Learning Objectives & Pretraining Assessment Point-of-Care Testing vs Laboratory-Based Testing Confirmatory Tests Availability of Results Point-of-Care Testing Issues Key Resources for Understanding and Employing HIV Testing Technologies Summary References Assessment Questions Case Studies Suggested Activities	Guidelines on Starting Antiretroviral Therapy Updated HIV treatment guidelines issued by the US Department of Health and Human Services (DHHS) in October 2011 recommend initiation of antiretroviral therapy for HIV-infected patients who belong to the following categories: [ DHHS Guidelines] Have a history of an AIDS-defining illness or a CD4+cell count < 350 cells/mm3 Have CD4+ cell count of 350 to 500 cells/mm3 Any CD4+ cell count plus any of the following conditions: HIV-associated nephropathy or hepatitis B virus (HBV) coinfection that requires treatment Pregnant women who do not otherwise meet the criteria for treatment, with the goal of preventing perinatal transmission Have CD4+ cell count > 500 cells/mm3 (However, 50% of the members of the panel that developed the guidelines regard treatment at this level as optional) Patients in any of these categories should be willing and able to commit to lifelong treatment and should understand the benefits and risks of therapy and the importance of adherence, and clinicians may recommend delaying the start of therapy based on a patient’s clinical and/or psychosocial factors. [DHHS Guidelines] Another benchmark set of HIV treatment guidelines, from the 2010 International AIDS Society (IAS)-USA, recommends that HAART should be started in all patients with CD4+ cell counts ≤ 500 cells/mm3 and should be considered in patients with CD4+ cell counts > 500 cells/mm3.[Thompson 2010] The IAS-USA guidelines also recommend initiating treatment for the following categories of HIV patients: Those with symptomatic HIV disease All pregnant women Those having HIV-1 RNA > 100,000 copies/mL Those experiencing rapid CD4+ cell count decline (> 100 cells/mm3/per year) Those with Active HBV or hepatitis C virus (HCV) coinfection Current or at high risk for cardiovascular disease HIV-associated nephropathy Symptomatic acute HIV infection Those at high risk for secondary HIV transmission—eg, serodiscordant couples « BACK NEXT »
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3. Promoting HIV Testing in Diverse Populations

Guidelines on Starting Antiretroviral Therapy