Section 3: Selecting ART


When to start ART?

Recommendations from guidelines today

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§ Treat in specific circumstances such as HCV/HBV coinfection, HIV-AN or other deficiency, VL >105 copies/mL, CD4 decline >50-100 cells/mm3 per year, >50 years, pregnancy, high CV risk or malignancy; † Generally defer treatment, closer follow up if VL >105 copies/mL . Treatment can be offered if presence of one or more of previous co-morbid conditions (CD4 350–500); *Consider treatment in specific groups such as AIDS diagnosis, HCV/HBV coinfection, low CD4 percentage, established or high risk of CVD, discordant couples; ‡ ART should be considered unless patient is an elite controller (HIV-1 RNA 50 copies/mL) or has stable CD4 cell count and low-level viremia in the absence of ART. 1. DHHS Guidelines 2011. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed March 2011; 2. EACS Guidelines 2011. Available at http://www.europeanaidsclinicalsociety.org/guidelinespdf/EACS-EuroGuidelines_FullVersion.pdf. Accessed March 2011; 3. Gazzard B et al., HIV Medicine 2008;9:563–608; 4. Thompson MA et al., JAMA 2010;304:321–333


Impact of menopause status on HIV treatment

1. Patterson KB, et al. Clin Infect Dis 2009;49:473–76; 2. Patterson K, et al. 18th CROI 2011. Abstract 32


Potential drug–drug interactions in older patients

A list of antiretroviral drug interactions can be found at: http://www.hiv-druginteractions.org/

1. Robertson SM, et al. Expert Opin Pharmacother 2005;6:233–53
2. Gazzard BG, et al. HIV Medicine 2008;9:563–608


SHCS: Number of co-medications in patients with HIV stratified by age

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Available at: http://pcwww.liv.ac.uk/ehls/back/HIV-ageing/. Accessed March 2011


Treatment guidelines for the third agent do not differentiate between men and women (except those planning pregnancy/who are pregnant)

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1. http://www.europeanaidsclinicalsociety.org/guidelinespdf/EACS-EuroGuidelines_FullVersion.pdf. Accessed March 2011.
2. http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf. Accessed March 2011.
3. Thompson MA et al. JAMA 2010; 304:321–333.


Case presentation continued

Fictitious case. Case studies are representative only and individual responses may vary