ANTIRETROVIRAL THERAPY FOR HIV-INFECTION IN 1998 - UPDATED RECOMMENDATIONS OF THE INTERNATIONAL AIDS SOCIETY USA PANEL

Objective.-To provide recommendations for antiretroviral therapy based on information available in mid-1998. Participants.-An international panel of physicians with expertise in antiretroviral research and care of patients with human immunodeficiency virus (HIV) infection, first convened by the International AIDS Society-USA in December 1995. Evide nce.-The panel reviewed available clinical and basic science study res ults (including phase 3 controlled trials; clinical, virologic, and im munologic end point data; data presented at research conferences; and studies of HIV pathophysiology); opinions of panel members were also c onsidered. Recommendations were limited to drugs available in mid-1998 . Consensus Process.-Panel members monitor new clinical research repor ts and interim results. The full panel meets regularly to discuss how the new information may change treatment recommendations. Updated reco mmendations are developed through consensus of the entire panel at eac h stage of development. Conclusions.-Accumulating data from clinical a nd pathogenesis studies continue to support early institution of poten t antiretroviral therapy in patients with HIV infection. A variety of combination regimens show potency, expanding choices for initial regim ens for individual patients. Plasma HIV RNA assays with increased sens itivity are important in monitoring therapeutic response; however, mor e data are needed to determine precisely the HIV RNA levels that defin e treatment failure. Long-term adverse drug effects are beginning to e merge, requiring ongoing attention. Some issues regarding optimal long -term approaches to antiretroviral management are unresolved. The incr eased complexity in HIV management requires ongoing monitoring of new data for optimal treatment of HIV infection.