HIV Treatment Initiation, Adherence Get New Guidelines

Laurie Barclay, MD

March 07, 2012

March 7, 2012 — An expert panel from the International Association of Physicians in AIDS Care (IAPAC) has developed evidence-based guidelines to improve antiretroviral therapy (ART) initiation, retention, and adherence for persons infected with HIV. The new recommendations were published online March 5 in the Annals of Internal Medicine.

"Over the last 15 years, we have made astounding progress in HIV treatment, resulting in longer and healthier lives for people living with HIV," IAPAC Panel Co-Chair Melanie A. Thompson, MD, principal investigator of the AIDS Research Consortium of Atlanta, Georgia, said in a news release. "Yet many people are unable to optimally benefit from these advances because of delayed diagnosis and multiple challenges to entering and staying in medical care."

According to the US Centers for Disease Control and Prevention, only 28% of persons with HIV in the United States have achieved viral suppression on ART, just 69% of those who knew they had HIV were linked to care, and only 59% were retained in care. ART adherence plays a key role in ensuring successful outcomes from HIV treatment, including adequate suppression of HIV replication, lower rates of resistance to HIV therapy, slower disease progression, delayed AIDS-related mortality, and reduced rates of HIV transmission.

"Once receiving potent treatment for HIV, many struggle to take their drugs consistently," Dr. Thompson said in the release. "Unfortunately, missed doses and drug holidays lead to resistant virus and, often, to treatment failure. Ultimately, both individual and public health depend on helping patients to successfully negotiate all of the steps of this treatment cascade."

More Than 300 Studies Included

A systematic literature search identified randomized controlled trials and observational studies reporting on at least 1 measured biological or behavioral outcome. After reviewing 325 pertinent published studies meeting selection criteria, the IAPAC panel developed 5 recommendations regarding entry into and retention in HIV medical care, as well as 5 recommendations regarding monitoring ART adherence.

The latter group includes ART regimen-specific strategies, adherence tools designed for patients, education and counseling interventions, and health system and service delivery interventions. Additional recommendations also address special populations such as pregnant women, patients with substance use disorders or mental health disorders, incarcerated individuals, the homeless, and children and adolescents.

"These guidelines are the foundation of an evolving blueprint that practitioners and health systems can use as a resource to improve entry into and retention in HIV care as well as adherence to HIV treatments," Dr. Thompson said.

Implementation of New IAPAC Recommendations

To help disseminate and implement the new recommendations, IAPAC is releasing a multidisciplinary, continuing education–accredited, online activity targeting physicians, nurses, pharmacists, and psychologists. Other strategies to improve health and HIV literacy and compliance with guidelines-recommended behavioral interventions include peer educator and patient-oriented activities.

"IAPAC is proud of the work advanced by our Panel in developing these pioneering guidelines, which we hope will help strengthen the three pillars of HIV treatment success — entry into and retention in care, as well as ART adherence," said IAPAC President José M. Zuniga, PhD, MPH, in the news release. "We have known for some time that much more attention is required to optimize the way in which HIV-positive patients are linked to and retained on HIV treatment so that they derive the full benefit of existing care, treatment, and support. These guidelines are an important step in that direction."

IAPAC and the US National Institutes of Health's Office of AIDS Research jointly sponsored development of these guidelines.

Ann Intern Med . Published online March 5, 2012. Full text


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