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  4. Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel.
 
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Titre

Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel.

Type
synthèse (review)
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Journal of the American Medical Association  
Auteur(s)
Günthard, H.F.
Auteure/Auteur
Aberg, J.A.
Auteure/Auteur
Eron, J.J.
Auteure/Auteur
Hoy, J.F.
Auteure/Auteur
Telenti, A.
Auteure/Auteur
Benson, C.A.
Auteure/Auteur
Burger, D.M.
Auteure/Auteur
Cahn, P.
Auteure/Auteur
Gallant, J.E.
Auteure/Auteur
Glesby, M.J.
Auteure/Auteur
Reiss, P.
Auteure/Auteur
Saag, M.S.
Auteure/Auteur
Thomas, D.L.
Auteure/Auteur
Jacobsen, D.M.
Auteure/Auteur
Volberding, P.A.
Auteure/Auteur
Groupes de travail
International Antiviral Society-USA Panel
Liens vers les personnes
Telenti, Amalio  
Liens vers les unités
Institut universitaire de microbiologie  
ISSN
1538-3598
Statut éditorial
Publié
Date de publication
2014
Volume
312
Numéro
4
Première page
410
Dernière page/numéro d’article
425
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article ; Practice Guideline ; Research Support, Non-U.S. Gov't Publication Status: ppublish PDF: Special Communication
Résumé
IMPORTANCE: New data and antiretroviral regimens expand treatment choices in resource-rich settings and warrant an update of recommendations to treat adults infected with human immunodeficiency virus (HIV).
OBJECTIVE: To provide updated treatment recommendations for adults with HIV, emphasizing when to start treatment; what treatment to start; the use of laboratory monitoring tools; and managing treatment failure, switches, and simplification.
DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS: An International Antiviral Society-USA panel of experts in HIV research and patient care considered previous data and reviewed new data since the 2012 update with literature searches in PubMed and EMBASE through June 2014. Recommendations and ratings were based on the quality of evidence and consensus.
RESULTS: Antiretroviral therapy is recommended for all adults with HIV infection. Evidence for benefits of treatment and quality of available data increase at lower CD4 cell counts. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (NRTIs; abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine) and a third single or boosted drug, which should be an integrase strand transfer inhibitor (dolutegravir, elvitegravir, or raltegravir), a nonnucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine) or a boosted protease inhibitor (darunavir or atazanavir). Alternative regimens are available. Boosted protease inhibitor monotherapy is generally not recommended, but NRTI-sparing approaches may be considered. New guidance for optimal timing of monitoring of laboratory parameters is provided. Suspected treatment failure warrants rapid confirmation, performance of resistance testing while the patient is receiving the failing regimen, and evaluation of reasons for failure before consideration of switching therapy. Regimen switches for adverse effects, convenience, or to reduce costs should not jeopardize antiretroviral potency.
CONCLUSIONS AND RELEVANCE: After confirmed diagnosis of HIV infection, antiretroviral therapy should be initiated in all individuals who are willing and ready to start treatment. Regimens should be selected or changed based on resistance test results with consideration of dosing frequency, pill burden, adverse toxic effect profiles, comorbidities, and drug interactions.
Sujets

Adult

Anti-HIV Agents/admin...

Anti-HIV Agents/adver...

CD4 Lymphocyte Count

Drug Costs

Drug Resistance, Vira...

Drug Therapy, Combina...

HIV Infections/diagno...

HIV Infections/drug t...

Humans

Treatment Failure

PID Serval
serval:BIB_232206737006
DOI
10.1001/jama.2014.8722
PMID
25038359
WOS
000339257800027
Permalien
https://iris.unil.ch/handle/iris/97461
Open Access
Oui
Date de création
2014-08-22T15:56:05.504Z
Date de création dans IRIS
2025-05-20T18:20:49Z
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