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Guidelines: Improving Retention & Treatment Adherence in HIV

Patient adherence to antiretroviral therapy (ART) is one of the most impor­tant factors associated with successful HIV outcomes. Following a diagnosis, timely entry into HIV medical care is essential to the provision of ART. However, of the approxi­mately 1.2 million people in the United States with HIV, only 69% are linked to care. For those who start care, only about 59% are retained in care. Among people with HIV who are on ART, just 28% have undetectable viral loads, which indicate high adherence to therapy. The varied and complex evidence base resulting from more than 20 years of research in these areas had until recently not been fully evaluated. In an effort to improve entry and retention in care as well as ART adherence in patients with HIV, a guidelines committee sponsored by the International Association of Physicians in AIDS Care and the NIH Office of AIDS Research published evidence-based guidelines in the Annals of Internal Medicine. Click here to view the full guidelines. Key Recommendations Melanie A. Thompson, MD, who was the lead author of the guideline document, says that the recommenda­tions set a high bar for meeting the standard of evidence. “We systematically reviewed literature from domestic and international studies that have been published since 1996,” she says. After reviewing 325 randomized controlled trials and observational studies that met stringent criteria for high-quality, comparative evidence, the expert panel arrived at 37 recommendations to assist clinicians in their care of people with HIV, several of which are particularly notable (Table 1). “All patients should receive some form of one-on-one ART education and adherence support.” According to Dr. Thompson,...

Antiretroviral Therapy in HIV Infection: A Guideline Update

Successful antiretroviral therapy (ART) has been linked to dramatic decreases in HIV- and AIDS-defining conditions and their associated mortality. In 2008, the International AIDS Society–USA released guidelines on the timing of therapy, optimal regimen choices, and monitoring in patients with HIV. Since that time, treatment options have expanded, and knowledge on the initiation and long-term management of ART in adults with HIV infection has evolved. “Recent research has shed light on the role of ART in reducing the rates of serious non-AIDS events associated with uncontrolled HIV replication,” explains Melanie A. Thompson, MD. “Clinicians have also gained a better understanding of the efficacy, toxicity, and potential uses of newer drugs. As such, an expert panel was convened to update the International AIDS Society–USA guidelines for the use of ART in adults with HIV infection.” The updated guidelines were presented at the AIDS 2010: XVIII International AIDS Conference and published in the July 21, 2010 JAMA. The Need for Early Initiation of ART Clinical studies have shown that progressive damage occurs during asymptomatic HIV infection. “This underscores the potential benefit of ART, even when the risk of traditional AIDS-defining diseases is relatively low,” says Dr. Thompson, who chaired the International AIDS Society–USA antiretroviral therapy guidelines consensus panel. Dr. Thompson notes that non-AIDS events are now a major contributor to morbidity and mortality in persons with HIV infection. “Uncontrolled HIV replication is associated with immune activation and inflammation, and these are associated with non-AIDS illnesses,” she says. “This suggests that viral suppression with ART might improve survival and quality of life for patients. Multiple studies have now shown this to be...
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