CBO-richtlijn: 'Antiretrovirale behandeling in Nederland'

Abstract

In collaboration with the Dutch Institute for Health Care Improvement (CBO) and on the basis of recent developments, new guidelines have been developed for the diagnosis and treatment of HIV-infected patients. The most important recommendations are: - Treatment of adult patients is indicated if HIV load > 30,000 RNA copies/ml, or when CD4+ cell count is 5,000 copies/ml, even when CD4+ cell count is > 500 x 106 cells/l. - Optimal antiretroviral treatment consists of a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor, or a combination of two NRTIs and one non-nucleoside reverse transcriptase inhibitor. - Patients on antiretroviral treatment should be monitored every 3 months. - Undetectable HIV load should be the target of first- or second-line antiretroviral treatment. - In order to prevent HIV transmission from mother to child, prescription of antiretroviral drugs after the first three months of pregnancy is indicated in pregnant women with a detectable HIV load. - Prophylaxis of opportunistic infections can be discontinued if CD4+ cell count recovers above 200 × 106/l. - In case of exposure to HIV due to a needle or other occupational accident or unsafe sexual contact, post-exposure prophylaxis should be offered after careful risk evaluation. - Preferably, vaccination to prevent pneumococci infections, influenza, hepatitis A or hepatitis B should be given when CD4+ cell count is > 200 x 106/l