British HIV Association (BHIVA) guidelines for the treatment of HIV‐infected adults with antiretroviral therapy

1.0 Synopsis 1.1 When to start treatment 1.2 Initial therapy 1.3.1 When to switch therapy for virological failure 1.3.1 Which drugs to use following failure of initial therapy 1.4 When to switch therapy in the absence of virological failure 1.5 Resistance testing 1.6 Therapeutic drug monitoring (TDM) 1.7 New drugs likely to be used in the near future 1.7.1 Atazanavir 1.7.2 Enfuvirtide (T20) 2.0 Introduction 2.1 Purpose of guidelines 2.2 Basing recommendations on evidence 2.3 Use of evidence published as abstracts 2.4 Implication for research 2.5 Use of surrogate marker data 2.6 Issues concerning design and analysis of clinical trials 2.6.1 Trial designs 2.6.2 Method of analysis 2.6.3 Intention to treat and on treatment analysis 2.6.4 Equivalence 2.6.5 Cross-study comparisons: presentation of data 2.7 Adverse event reporting 3.0 When to start treatment 3.1 Primary HIV infection 3.1.1 Treatment of primary HIV infection to alter the natural history 3.1.2 Use of structured treatment interruption (STI) in acute infection 3.1.3 Treatment during PHI for immediate clinical benefit 3.1.4 Treatment during PHI to reduce onward transmission 3.1.5 Recommendations for starting treatment in PHI (CIII) 3.2 Symptomatic HIV infection 3.3 Asymptomatic HIV infection 3.3.1.1 Individuals with CD4 counts 3 3.3.1.2 Individuals with CD4 counts 4350 3.3.1.3 Individuals with CD4 counts 201-350 cells/mm 3.1.6 Recommendations regarding asymptomatic chronic HIV infection 4.0 What to start with 4.1 Choices of initial therapy 4.2 Which HAART regimen is best? 4.2.1 Two NRTIs plus an NNRTI 4.2.1.1 Efavirenz (EFV) 4.2.1.2 Nevirapine (NVP) 4.2.1.3 Delavirdine 4.2.2 Two NRTIs plus a PI 4.2.2.1 Two NRTIs plus a boosted PI 4.2.3 Three NRTIs 4.3. Choice of NRTI backbone for initial therapy 4.4. Recommendations for initial therapy: conclusions 5.0 Issues concerning antiretroviral use 5.1 Follow up of the HIV patient 5.2 Adherence 5.3 Toxicity 5.3.1 Lipodystrophy 5.3.1.1 Management of lipodystrophy 5.3.1.2 Other therapies 5.3.1.3 Conclusions 5.3.2 Mitochondrial toxicity and lactic acidosis 5.3.2.1 Aetiology of NRTI induced mitochondrial toxicity Correspondence: Dr Anton Pozniak and Professor Brian Gazzard, Chelsea and Westminster Hopspital, 369 Fulham Road, London SW10 9NH, UK. e-mail: anton.pozniak@chelwest.nhs.uk