ANTIRETROVIRAL THERAPY FOR HIV-INFECTION IN 1997 - UPDATED RECOMMENDATIONS OF THE INTERNATIONAL-AIDS-SOCIETY USA PANEL

Objective.-To provide current recommendations for antiretroviral thera py for human immunodeficiency virus (HIV) disease. Participants.-The o riginal International AIDS Society-USA 13-member panel representing in ternational expertise in antiretroviral research and care of patients with HIV infection. Evidence.-The following were considered: Newly ava ilable clinical and basic science study results, including phase 3 con trolled trials; clinical, virological, and immunologic end-point data; interim analyses of studies presented at national and international r esearch conferences; studies of HIV pathophysiology; and expert opinio ns of panel members. Recommendations were limited to the drugs availab le in mid 1997. Process.-The full panel met on a regular basis (July 1 996, September 1996, November 1996, January 1997, and April 1997) sinc e the publication of its initial recommendations in mid 1996 to review new research reports and interim results. The panel discussed whether and how new information changed its initial recommendations. The reco mmendations contained herein were determined by group consensus. Concl usions.-New data have provided a stronger rationale for earlier initia tion of more aggressive therapy than previously recommended and reinfo rce the importance of careful selection of initial drug regimen for ea ch patient for optimal long-term clinical benefit and adherence. The p lasma viral load is a crucial element of clinical management for asses sing prognosis and the effectiveness of therapy, and such testing must be done properly. Treatment failure is most readily indicated by a ri sing plasma HIV RNA level and should be confirmed prior to a change of treatment. Therapeutic approaches must be updated as new data, partic ularly on the long-term clinical effect of aggressive antiretroviral t reatment, continue to emerge.