1. The strategic management of antiretroviral therapy (SMART)4 trial confirmed that untreated HIV patients have increased HIV-related morbidity and mortality with declining CD4 counts, but also increased mortality attributed to conditions that have previously not been recognised to be HIV-related, such as non-AIDS malignancies.
This trial indicated that treatment-naive patients, or those who were not receiving treatment for the previous six months, had a risk of opportunistic infection or serious non-AIDS event of seven per 100 patient-years compared with 1.6 per 100 patient-years in the virological suppression arm.
This trial strongly supports the lifelong continuation of antiretroviral treatment and discourages 'drug holidays'.
2. AIDS Clinical Trial Group 5142 was an open label randomised trial which showed that efavirenz was potent long term at high viral loads when compared with a boosted protease inhibitor. (N Engl J Med 2008; 358: 2095-106).
Therefore the non-nucleoside analogue efavirenz remains alongside the nucleoside analogue backbone, a first choice regimen when starting antiretrovirals.
1. UK National HIV testing guidelines 2008. These guidelines emphasise that HIV is treatable and patients with HIV indicator diseases should be offered an HIV test. www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf
2. BHIVA published and approved guidelines in 2008 www.bhiva.org
Madge S, Matthews P, Singh S et al. Management of HIV in Primary Care. Medical Foundation for AIDS and Sexual Health. (revised April 2005 and downloadable at www.medfash.org)
The RCGP covers this topic in statement 11 Sexual Health
1. Health Protection Agency www.hpa.org.uk. Further epidemiology data on HIV can be found under topics AIDS/HIV.
2. Guidance on various drug interactions can be found at www.hiv-druginteractions.org
Contributed by Dr Charlotte Hopkins and Dr R Monica Lascar, consultants in HIV and genitourinary medicine at Whipps Cross University Hospital, London.