CBO-richtlijn 'Antiretrovirale behandeling in Nederland'

- 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 < 350 × 10⁶ cells/l.

- Treatment of children is indicated if HIV load > 5,000 copies/ml, even when CD4⁺ cell count is > 500 × 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 × 10⁶/l.