Adult antiretroviral therapy guidelines 2017

These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2014 and the update on when to initiate antiretroviral therapy in 2015. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. New antiretroviral drugs have become available with improved efficacy, safety and robustness. The guidelines are intended for countries in the southern African region, which vary between lower and middle income

Guidelines for antiretroviral therapy in adults by the Southern African HIV clinicians society

These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in January 2008. Since the release of the previous guidelines, the scaleup of antiretroviral therapy (ART) in Southern Africa has continued to grow. Cohort studies from the region show excellent clinical outcomes; however, ART is still being started late (in advanced disease), resulting in relatively high early mortality rates. New data on antiretroviral (ARV) tolerability in the region and several new ARV drugs have become available. Although currently few in number, some patients in the region are failing protease inhibitor (PI)- based second-line regimens. To address this, guidelines on third-line (or ‘salvage’) therapy have been expanded.Specific recommendations provided here are intended only as a guide to clinical therapy, based on expert consensus and best current evidence. Treatment decisions for patients should be made by their responsible clinicians, with due consideration for individual circumstances. The most current version of this document should always be consulted.All expert panel members have completed and submitted conflict of interest disclosure forms. Disclosure information represents the previous 3 years (updated 17 August 2012) and includes relationships with pharmaceutical companies and medical aids: Dr Francesca Conradie has received support from Abbott to attend conferences, and research support from Tibotec. She has also received honoraria for speaking engagements from Abbott and MSD. Dr Hefer has received support to attend conferences from Abbott, Adcock Ingram, Aspen and MSD. He owns shares in Lifecell and has received honoraria for speaking engagements from Abbott, Aspen and MSD. Dr Johnson has received research support from Bristol Myers Squibb (BMS), MSD, Tibotec and Schering-Plough. He has also received honoraria for speaking engagements from Abbott. Professor Graeme Meintjes has received honoraria for speaking engagements from Sanofi Aventis and serves as a consultant for Aid for AIDS. Professor Yunus Moosa has received support to attend conferences from Abbott and honoraria for speaking at conferences/seminars from Abbott, Aspen, MSD and Pfizer. Dr Theresa Rossouw serves as a consultant for Discovery Health. Dr Ebrahim Variava receives support for clinical trials from Outsuka. Professor Francois Venter has received support to attend conferences from Adcock Ingram and MSD; honoraria for speaking engagements from MSD; and has served as a consultant for Abbott, Johnson and Johnson and Tibotec. Dr Eric Goemaere, Professor Gary Maartens, Dr Moeketsi Mathe, Dr Regina Osih and Dr Gilles Van Custem report no conflicts of interest.This work is supported and funded by the Southern African HIV Clinicians Society through an educational grant from Atlantic Philanthropies.www.sajhivmed.org.zaam201

Appropriate clinical use of darunavir 800 mg

No abstract available

Southern African HIV Clinicians Society Guidance on the use of dolutegravir in first-line antiretroviral therapy

No abstract available

Efficacy of Once Daily Darunavir/Ritonavir in PI-Naïve, NNRTI-Experienced Patients in the ODIN Trial

Background. An exploratory subanalysis of the ODIN trial was performed to evaluate the efficacy of darunavir/ritonavir (DRV/r) 800/100 mg OD versus 600/100 mg BID in patients who were NNRTI-experienced but PI-naïve. Methods. ODIN was a phase III, 48-week study comparing DRV/r OD versus BID in 590 treatment-experienced patients with no DRV resistance-associated mutations (RAMs) at screening. Patients received DRV/r 800/100 mg OD or DRV/r 600/100 mg BID plus ≥2 NRTIs. Of the 590 patients randomized, 272 (46%) were NNRTI-experienced but PI-naïve. Results. Overall, 272 patients received DRV/r OD n=135 or BID n=137 plus ≥2 optimised NRTIs. The mean age was 39 years; 35% were female; 27% were Black, 24% Caucasian, 26% Oriental/Asian, and 23% other races; 17% were recruited in South Africa; and 48% had non-B HIV-1 subtypes. Mean baseline plasma HIV-1 RNA load was 4.10 log10⁡ copies/mL; median CD4 cell count was 258 cells/μL. At week 48, 111/135 (82%) of DRV/r OD and 109/137 (80%) of DRV/r BID patients achieved an HIV-1 RNA load <50 copies/mL. No patient developed primary PI RAMs. Conclusion. DRV/r 800/100 mg OD in combination with ≥2 optimised NRTIs led to virological suppression <50 copies/mL in 82% of NNRTI-experienced, PI-naïve patients by week 48

Southern African HIV Clinicians Society adult antiretroviral therapy guidelines: Update on when to initiate antiretroviral therapy

The most recent version of the Southern African HIV Clinicians Society’s adult antiretroviral therapy (ART) guidelines was published in December 2014. In the 27 August 2015 edition of the New England Journal of Medicine, two seminal randomised controlled trials that addressed the optimal timing of ART in HIV-infected patients with high CD4 counts were published: Strategic timing of antiretroviral therapy (START) and TEMPRANO ANRS 12136 (Early antiretroviral treatment and/or early isoniazid prophylaxis against tuberculosis in HIV-infected adults). The findings of these two trials were consistent: there was significant individual clinical benefit from starting ART immediately in patients with CD4 counts higher than 500 cells/μL rather than deferring until a certain lower CD4 threshold or clinical indication was met. The findings add to prior evidence showing that ART reduces the risk of onward HIV transmission. Therefore, early ART initiation has the public health benefits of potentially reducing both HIV incidence and morbidity. Given this new and important evidence, the Society took the decision to provide a specific update on the section of the adult ART guidelines relating to when ART should be initiated

Adult antiretroviral therapy guidelines 2017

These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2014 and the update on when to initiate antiretroviral therapy in 2015. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. New antiretroviral drugs have become available with improved efficacy, safety and robustness. The guidelines are intended for countries in the southern African region, which vary between lower and middle income