GUIDELINES

UK (BHIVA) 2008 Treatment Guidelines published online

The 2008 BHIVA guidelines are now published online and are a significant revision of the 2006/7 guidelines.

Changes include:

Earlier discussions about starting treatment (ie once CD4 is <500 cells/mm³)
New tables to estimate progression risk
Recommendations to start treatment earlier (ie once CD4 count is <350 cells/mm³)
Consideration to start treatment when CD4% is <14%, even when absolute CD4 count remains >350 cells/mm³
In addition to symptomatic AIDS, starting or considering treatment with >350 cells/mm³ is also recommended for patients with hepatitis B or C coinfections, and importantly, patients with high cardiovascular risk (>20% 10-year Framingham risk).
Efavirenz is recommended as consideration for first-line therapy for all patients. Those with contraindications for efavirenz are recommended to use a boosted PI.
Atazanavir/r is now included as first-line treatment option.
Although Truvada and Kivexa are both recommended as dual-nuke backbone, the guidelines caution against using Kivexa for patients with baseline viral load >100,000 copies/mL or who have high cardiovascular risk (Framingham)
Resistance testing is routinely recommended for newly diagnosed patients, prior to starting treatment and prior to switching treatment, once viral rebound has been confirmed. Results should be communicated to patients, permanently recorded in patient notes and included in notes forwarded to other treatment centres should the patient change their clinic for any reason.
Broadening availability to earlier HIV testing

The guidelines are already available to download in PDF format From the BHIVA web site
http://www.bhiva.org

They will also be published in the Autumn issue of HIV Medicine.