GUIDELINES

British 2003 HIV treatment guidelines are published online

Simon Collins, HIV i-Base

The British HIV Association (BHIVA) has published the 2003 UK treatment guidelines online in both html and pdf file format.

http://www.bhiva.org/

http://www.bhiva.org/pdf/2003/guides/BHIVA_2003_Guidelines.pdf

This is the first major revision for more than two years and contains many significant changes. These include:

  • Treatment should aim to be initiated while CD4 count is above 200 cells/mm3 or at higher levels if symptomatic. Exact timing depends on various factors, including short-term risk.
  • Triple nucleoside combinations previously recommended such as Trizivir (AZT/3TC/abacavir) are not now recommended, even for patients with a lower baselines viral load.
  • d4T is not recommended for first line therapy due to increased association with lipodystrophy.
  • Unboosted PI regimens are not recommended for first choice due to poorer pharmacokinetics, and less convenient dosing.
  • The committee believes there is no definitive evidence on which to base a preference for either choice of nucleosides or choice of PI or NNRTI.
  • Considerations for regimens include ease of adherence and minimising toxicity, and should take account of individual factors such as hepatitis B/C, risk of cardiovascular disease, diabetes, psychiatric disease, and lifestyle.
  • Treatment in primary HIV infection is recommended if needed to relieve severe symptoms but is not generally recommended otherwise, unless as part of a clinical trial.
  • Use of resistance testing is recommended for all treatment naïve patients prior to starting treatment. In practice, this means that people should receive or have a sample stored for later testing when diagnosed.
  • Therapeutic drug monitoring (TDM) is seen as being of value in specific circumstances, such as reducing toxicity, and adjusting doses in significant hepatic or renal impairment.
  • Interrupting or stopping treatment may benefit patients who started treatment earlier than currently recommended – ie with a high pre-treatment CD4 count (specified as ‘perhaps 300 cells/mm3’). The importance of careful monitoring is stressed.
  • New sections include monitoring tests, management of patients who are using treatment combinations not now recommended in the guidelines (such as Trizivir or d4T), and a table on drug costs.
  • Sections on the management of side effects such as lactic acidosis, metabolic changes and lipodystrophy have been updated and include, for example, a stronger recommendation for New-Fill).

The guidelines will also be published as a supplement to the October issue of HIV Medicine.

HIV Treatment Bulletin Vol 4 No 8 October 2003