Antiretroviral therapy in adults - Updated recommendations of the International AIDS Society-USA Panel

Objective To update recommendations for antiretroviral therapy for adult hu man immunodeficiency virus type 1 (HIV-1) infection, based on new informati on and drugs that are available. Participants A 17-member international physician panel with antiretroviral research and HIV patient care experience initially convened by the Internat ional AIDS Society-USA in December 1995. Evidence Available clinical and basic science data including phase 3 contro lled trials; data on clinical, virologic, and immunologic end points; resea rch conference reports; HIV pathogenesis data; and panel expert opinion. Re commendations were limited to therapies available (US Food and Drug Adminis tration approved) in 1999. Consensus Process The panel assesses new research reports and interim resul ts and regularly meets to consider how the new data affect therapy recommen dations. Recommendations are updated via full-panel consensus. Guidelines a re presented as recommendations if the supporting evidence warrants routine use in the particular situation and as considerations if data are prelimin ary or incomplete but suggestive. Conclusions The availability of new antiretroviral drugs has expanded treat ment choices. The importance of adherence, emerging long-term complications of therapy, recognition and management of antiretroviral failure, and new monitoring tools are addressed. Optimal care requires individualized manage ment and ongoing attention to relevant scientific and clinical information in the field.