USA: Richtlinie empfiehlt antiretrovirale Therapie für alle HIV-Positiven

Die Leitlinien zur Behandlung der HIV-Infektion wurden in den USA aktualisiert. Empfohlen wird nun eine antiretrovirale Behandlung aller HIV-Positiven.

Mit der Aktualisierung werde u.a. den Feststellungen Rechnung getragen, dass fortdauernde HIV-Vermehrung schädliche Folgen habe; zudem solle dem positiven Effekt der antiretroviralen Therapie auf eine Verhinderung der HIV-Übertragung entsprochen werden.

Zentraler Satz: antiretrovirale Therapie werde allen HIV-Positiven empfohlen – „ART is recommended for all HIV-infected individuals.“ Die Stärke dieser Empfehlung variiere abhängig von der CD4-Zellzahl.

Die neue Richtlinie führt aus:

„Initiating Antiretroviral Therapy in Treatment-Naive Patients
The Panel updated its recommendations on initiation of ART in treatment-naive patients. The changes are primarily based on increasing evidence showing the harmful impact of ongoing HIV replication on AIDS and non-AIDS disease progression. In addition, the updated recommendations reflect emerging data showing the benefit of effective ART in preventing secondary transmission of HIV. The updated section includes more in-depth discussion on the rationale for these recommendations and on the risks and benefits of long-term ART.
The Panel’s recommendations are listed below.

• ART is recommended for all HIV-infected individuals. The strength of this recommendationa varies on the basis of pretreatment CD4 cell count:
  – CD4 count < 350 cells /mm³ (AI)
  – CD4 count 350 to 500 cells / mm³ (AII)
  – CD4 count >500 cells/mm³ (BIII)
• Regardless of CD4 count, initiation of ART is strongly recommended for individuals with the following conditions:
  – Pregnancy (AI) (see perinatal guidelines for more detailed discussion)
  – History of an AIDS-defining illness (AI)
  – HIV-associated nephropathy (HIVAN) (AII)
  – HIV/hepatitis B virus (HBV) coinfection (AII)
• Effective ART also has been shown to prevent transmission of HIV from an infected individual to a sexual partner. Therefore, ART should be offered to patients who are at risk of transmitting HIV to sexual partners (AI [heterosexuals] or AIII [other transmission risk groups]).
• Patients starting ART should be willing and able to commit to treatment and should understand the benefits and risks of therapy and the importance of adherence (AIII). Patients may choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors.“

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siehe auch:
ondamaris / Michèle Meyer 02.02.2012: Lasst uns aus der kollektiven Schockstarre des Verseuchtseins erwachen! Freut euch!
ondamaris / Ulrich Würdemann 22.07.2011: “treatment as prevention” – ein Konzept mit latent freiheitseinschränkenden Tendenzen?

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weitere Informationen:
U.S. Department of Health and Human Services 27.03.2012: Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (pdf)
AidsInfo 26.03.2012: Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents – What’s New in the Guidelines?
POZ 28.03.2012: Revised U.S. Guidelines: HIV Treatment is Recommended for All People Living With HIV
aidsmap 29.03.2012: New US treatment guidelines recommend antiretroviral treatment for all people with HIV
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