Start HIV study changes treatment guidelines across the planet
All HIV-positive people eligible for antiretroviral treatment should receive CD4, according to the new British HIV Association (BHIVA) treatment project, the study START HIV, That changes HIV guidelines.
The new design guidelines published for consultation this week, says someone living with HIV, and who understands the seriousness of the commitment to treatment, and are ready, psychologically speaking, to get the changes seropositive treatment guidelines, the Study, you should receive treatment. The change - from a recommendation to start treatment before the CD4 cell count falls below 350 cells per milliliter of blood for a treatment for all seropositive - follows the results of the START HIV study, an international study intensely expected on when to start treatment.
The START study showed that starting treatment with a CD4 count above 500 cells per cubic milliliter of blood has reduced the risk of death or serious illness in 53%, compared with waiting to start treatment until the CD4 count falls to 350 cells per cubic milliliter of blood. Although the absolute risk of death or serious illness is small - 3,7% people in the differentiated treatment arm became seriously ill or died, compared with 1.8% in the immediate treatment group, after more than three years of follow-up - the Committee of BHIVA guidelines concluded that the evidence now supports the provision of treatment to all people willing to receive it.
Two other recent studies, the Early Study and HPTN 052, also influenced the decision to offer treatment to all as the results of the start HIV study say.
Temprano, a study in West Africa showed that starting treatment at a cell count CD4 above 500 reduced the risk of severe disease and death in 44% compared to the beginning of treatment in low CD4 count.
The study HPTN 052 held in sub-Saharan Africa, India, Brazil, Thailand and the United States, showed that early treatment - starting with a CD4 cell count between 350 and 550 - reduced the risk of clinical disease 40%, but It did not significantly reduce the risk of death compared to starting treatment at a count of CD4 cells below 250 cells per cubic milliliter of blood.
HPTN 052 also showed that immediate treatment reduced the risk of sexual transmission of HIV in 96% [Soropositivo.org Editor's Note: Why, then, Lord, criminalize people living with HIV simply by not revealing their HIV status before beginning a sexual relationship?]. giving basis to the previous recommendation of BHIVA that someone living with HIV should have treatment initiated immediately reveal, because they believed that this could reduce the risk of transmission of HIV - and that all people living with HIV should be informed by their doctors evidence linking antiretroviral treatment for reducing the risk of transmission.
Data presented by the Health Surveillance of England, .no beginning of this year, show that this recommendation coincided with a substantial increase in the proportion of early treatment of people in CD4 count above 350 by the end of 2013 - but only 27 people started the treatment with a cell count CD4 above 500 that year.
The updated guidelines continue to emphasize this evidence and recommend that doctors should continue to discuss the transmission reduction potential for all people living with HIV. People living with HIV should be assessed for the immediate start of treatment after diagnosis, but the initiation of treatment should only be considered urgent for people with AIDS defining illness, bacterial infections severe or with a cell count below CD4 200 cells per cubic milliliter of blood. People in any of these categories should start treatment within two weeks at most, the guidelines recommend.
Recently infected persons - diagnosed with someone Primary HIV infection within 12 weeks after a previous negative test - should be encouraged to start treatment immediately in order to improve immune recovery, limit the size of the viral reservoir and limit the potential transmission of the disease at a time of very high viral load. Someone diagnosed with primary HIV infection who has a CD4 cell count below 350 cells per cubic milliliter of blood, one AIDS defining illnessor neurological symptoms should also be encouraged to start treatment so they can.
Other people diagnosed soon after infection should be invited to consider the initiation of treatment the same way as any other person diagnosed with HIV - when they feel prepared for it.
The guidelines also make a change more, recommending treatment based on efavirenz as the standard regimen for first-line treatment.
Efavirenz was at the heart of anti-retroviral first-line treatment in the UK for almost 15 years and has been the preferred choice of first line, since 2008, but recent experimental results have shown that some other agents are superior in some patient populations.
Trials have also reinforced doubts about the long-term tolerability of efavirenz.
Efavirenz has been downgraded to an alternative choice the first time. Instead, the guidelines now recommend that (in the UK) the first-line regimen should be based on:
- an integrase inhibitor - dolutegravir (Tivicay also available in pill "Triumeq" (a combination with abacavir and lamivudine), raltegravir (Isentress) or elvitegravircobicistat (Vitekta and Tybost also available in tablet Stribild combination with tenofovir and emtricitabine);
- one potentiating protease inhibitor (or atazanavirritonavir darunavirritonavir)
- the new inhibitor of reverse transcriptase non-nucleoside, rilpivirine (Edurant, also available in pill Eviplera combination with tenofovir and emtricitabine).
Doctors have been told to request information on the quality of sleep and mood in each clinical consultation of taking Efavirenz (In "ta Editor: Natasha RoxyOur collaborator, has reported "realistic dreams and unwillingness to work under effect of this medicine - Efavirenz, which has been used, according to anonymous reports, such as" recreational drug) in order to identify people who may benefit from switching to a drug better tolerated.
The preferred central axis for the first-line treatment remains the tenofovir and emtricitabine, with abacavir and lamivudine as an alternative where people do not have viral load above 100.000 copies per cubic milliliter of blood. Abacavir and lamivudine may be used in any viral load dolutegravir when combined with the fixed-dose combination pill Triumeq due to high power dolutegravir.
Abacavir is not suitable for use by people with a genetic profile that makes them hypersensitive to the drug, and everyone should be tested for the genetic marker HLA-B5701 to filter out people who are likely to be hypersensitive before starting treatment with the drug.
Abacavir should not be used in people at high risk of cardiovascular disease, and tenofovir should not be used in people with chronic kidney disease stage 3-5.
Published: June 24 2015
Translated from originalNew British guidelines recommend treatment for everyone with HIVby Claudio Souzawith Mara Macedo Review in July 28 2015
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