New HIV Treatment Guidelines Released- Out With The Old Guard

TREATMENT GUIDLINES-2On April 8th, 2015 the new Department of Health and Human Services (DHHS) HIV Treatment Guidelines were released.

There are several major changes to the guidelines and some of the biggest modifications are in the “What To Start” section, which are initial combination regimens for the antiretroviral – naïve patient.

There are now five recommended regimens, which include four Integrase Inhibitor, based regimens and one protease Inhibitor based regimen.

The Integrase Inhibitor regimens are the following:

  • Dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) ONLY for patients who are HLA-B*5701 negative (Triumeq)
  • Dolutegravir (DTG) (Tivicay) plus tenofovir/emtricitabine (TDF/FTC) (Truvada)
  • Elvitegravir/cobicistat/TDF/FTC (Stribild) ONLY for patients who have creatinine clearance (before starting therapy) of >70ml/min
  • Raltegravir (RAL) (Isentress) plus TDF/FTC (Truvada)

The Protease Inhibitor regimen is:

  • darunavir/ritonavir (DRV/r) (Prezista/Norvir) plus TDF/FTC (Truvada)

Two regimens that were previously recommended regimens have been moved to the Alternative Regimen category

  • Atazanavir/ritonavir (ATV/r) (Reyataz/Norvir) plus TDF/FTC (Truvada) which showed more toxicities than darunavir based regimen
  • Efavirenz/TDF/FTC (Atripla) due to tolerability issues especially a high rate of central nervous system toxicities (vivid dreams, insomnia, dizziness etc)

Three other regimens previously listed as recommended regimens have also been moved to the alternative category:

  • ATV/r (Reyataz/Norvir) plus ABC/3TC (Epzicom)
  • EFV (Sustiva) plus ABC/3TC (Epzicom)
  • Rilpivirine/TDF/FTC (Complera)
  • Coformulations with Atazanavir and darunavir with cobicistat (Evotaz and Prezcobix) have been added to the alternative category

Some other categories that have some changes are the following:

  • Virologic Failure
  • Poor CD4 Cell Recovery and Persistent Inflammation Despite Viral suppression
  • Acute/Early HIV Infection
  • HIV-2 Infection
  • HIV/Hepatitis C Coinfection
  • Drug Interactions

You can see “Whats New” here or Download the entire 288 page guidelines HERE