Projeto Riscobiologico.org

Prezados colegas,
Gostaríamos de divulgar a publicação de novos guidelines para o tratamento de infecção pelo HIV/AIDS entre adolescentes e adultos: http://www.aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?GuidelineID=7&ClassID=1.
Equipe Riscobiologico.org

"On October 14, 2011, updated Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents were made available through the AIDSinfo web site.
Guidelines for treating HIV-infected adults and adolescents, including utilization of resistance testing, initiation of treatment, preferred first-line regimens, adverse events to antiretroviral medications, managing treatment-experienced patients, and considerations for special populations.
This revision to the guidelines is focused on What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient. Additions and key changes to the section are outlined below. More detailed discussion of the rationale for changes to the
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What to Start recommendations can be found in the updated section. Tables in the guidelines corresponding to the What to Start section have also been updated to reflect changes.
Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-Based Regimens
Rilpivirine added as an alternative NNRTI option for initial therapy in treatment-naive patients.
All nevirapine-based regimens reclassified as acceptable options for treatment-naive patients (females with pretreatment CD4 count <250 cells/mm3 or males with pretreatment CD4 count <400 cells/mm3). Previously, "nevirapine + zidovudine/lamivudine" was classified as an alternative regimen and "nevirapine + abacavir/lamivudine" and "nevirapine + tenofovir/emtricitabine" were recommended as regimens that may be acceptable but should be used with caution.
Protease Inhibitor (PI)-Based Regimens
"Ritonavir-boosted darunavir + abacavir/lamivudine" reclassified as an alternative regimen (BIII); previously the regimen was recommended as a regimen that may be acceptable but more definitive data are needed (CIII).
Regimens with unboosted fosamprenavir removed as PI options for treatment-naive patients. The Panel removed the regimens because they have inferior potency compared with other PI-based regimens and because of the potential for ion of mutations that confer resistance to darunavir in patients who experience virologic failure while on these regimens.
Raltegravir-Based Regimens
"Raltegravir + abacavir/lamivudine" reclassified as an alternative regimen (BIII); previously, the regimen was classified as a regimen that may be acceptable but more definitive data are needed (CIII).
Dual-Nucleoside Reverse Transcriptase Inhibitor (NRTI) Options
"Zidovudine + lamivudine" reclassified from an alternative dual-NRTI option to an acceptable option because the combination has greater toxicities compared with tenofovir/emtricitabine and abacavir/lamivudine and requires twice daily dosing. However, zidovudine + lamivudine remains as the preferred dual-NRTI for pregnant women receiving antiretroviral therapy (ART) for prevention of perinatal transmission of HIV.
"Didanosine + lamivudine" removed as a dual-NRTI option for initial therapy because the combination has the least clinical trial experience and greater toxicity compared with other available dual-NRTI options.
Discussion on the association between abacavir use and the risk of a cardiovascular event updated.
In addition to the changes highlighted above, the following tables are updated with information relevant to rilpivirine:
- Tables 14, 15b, and 16b - Drug interaction tables
- Appendix B, Table 2 - Drug characteristic table
- Appendix B, Table 7 - Dosing recommendation for patients with renal or hepatic insufficiency"
Fonte: Mailing U.S. Food & Drug Administration (FDA)

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