Herziene richtlijn 'Antiretrovirale behandeling'

– 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 × 10⁶/l.

– Antiretroviral therapy is recommended when CD4-cell levels are 200-350 cells × 10⁶/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.

Ned Tijdschr Geneeskd. 2005;149:2399-405