BRITISH HIV ASSOCIATION GUIDELINES FOR ANTIRETROVIRAL TREATMENT OF HIV-SEROPOSITIVE INDIVIDUALS

Only incomplete data are available to guide decisions on anti-HIV trea tment. A British HIV Association consensus is that guidance must draw on other evidence besides the randomised trial. Marker studies, work o n disease pathogenesis and viral dynamics, and expanding knowledge of resistance patterns mean that the approach to therapy is constantly ev olving. There is a need for well-informed dialogue between HIV-infecte d patient and physician to achieve rational, Individualised treatment. However, the following broad principles have a wide consensus amongst HIV-treating physicians in the UH: (1) treatment should be offered be fore substantial immunodeficiency ensues; (2) initial treatment should include combinations of at least two drugs; (3) switches in therapy s hould involve substitution or addition of at least two new agents; (4) viral load and CD4 measurements are essential; (5) reduction in viral load to below the detection level of a sensitive assay represents the optimal treatment response and failure to achieve or sustain this con trol should prompt consideration of therapy modification. This respons e seems to be achieved most reliably with combinations of two nucleosi de analogues plus a third agent (a protease inhibitor, a nonnucleoside reverse-transcriptase inhibitor, or a third nucleoside analogue) or o f two protease inhibitors.