[Revised guideline "Antiretroviral Treatment"].Ned Tijdschr Geneeskd. 2005 Oct 22; 149(43):2399-405.NT
In the revised guideline 'Antiretroviral treatment' produced by the Dutch Society of Aids-Treating Physicians and the Dutch Institute for Healthcare Improvement (CBO), the following major changes have been made to the 2000 guideline. Treatment of adult HIV-infected patients should start when the number of CD4 cells remains consistent at >200 cells x 10(6)/l. Antiretroviral therapy is recommended when CD4-cell levels are 200-350 cells x 10(6)/l and HIV-RNA load is higher than 100,000 copies/ml. In therapy-naive adults combinations of 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus 1 non-nucleoside reverse transcriptase inhibitor (NNRTI) and combinations of 2 NRTIs plus 1 protease inhibitor are equally effective; NNRTIs are preferable to protease inhibitors due to their relatively easy dosage regimen. In order to optimize individual dosage regimens, plasma drug levels should be measured at 4 and 24 weeks after the start of treatment in therapy-naive patients. Patients with pre-existing disturbances of lipid metabolism or familial hypercholesterolaemia should not receive protease inhibitors as therapy of first choice. Genotyping is indicated in virological failure and before the start of initial therapy in patients infected in Europe and the United States of America. In order to prevent HIV transmission from mother to child, all pregnant HIV-infected women (also if their HIV-RNA load is undetectable) should receive HIV treatment starting in the 24th week of gestation. Children of HIV-seropositive mothers should be treated with antiretrovirals for 4 weeks after birth. In co-infected patients, the choice of anti-hepatitis B drugs should be determined by whether or not there is also an indication for HIV treatment. Treatment for tuberculosis should preferably be initiated 1-2 months prior to the start of HIV treatment in co-infected patients. Following an occupational needlestick accident or unprotected-sex event, post-exposure prophylaxis should be offered due to the increased risk of HIV transmission.