Medicine is an ever-changing science. Research and clinical experience are continually expanding our
knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors,
and publisher have made every effort to ensure that all information in this book is in accordance with the
state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher
are not responsible for errors or omissions or for any consequences from application of the information in
this book and make no warranty, express or implied, with respect to the contents of the publication. Every
reader should examine carefully the package inserts accompanying each drug and should carefully check
whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer
differ from the statements made in this book. Such examination is particularly important with drugs that
are either rarely used or have been newly released on the market.
In 1995, the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) developed
guidelines for preventing opportunistic infections (OIs) in persons infected with human immunodeficiency virus (HIV)
(1-3). These guidelines, written for health-care providers and patients, were revised in 1997 (4) and again in 1999 (5),
and have been published in the MMWR (1,4,5), Clinical Infectious Diseases (2,6,7), the Annals of Internal Medicine
(3,8), the American Family Physician (9,10), and Pediatrics (11); accompanying editorials have appeared in JAMA
(12,13). Response to these guidelines (e.g., the many requests for reprints, numerous web site contacts, and observations
from health-care providers) suggests they have served as a valuable reference for HIV care providers. Because the 1995,
1997, and 1999 guidelines included ratings indicating the strength of each recommendation and the quality of supporting
evidence, readers have been able to assess the relative importance of each recommendation.
Since AIDS was first recognized 20 years ago, remarkable progress has been made in improving the quality and duration
of life of HIV-infected persons in the industrialized world. During the first decade of the epidemic, this improvement
occurred because of better recognition of opportunistic disease processes, better therapy for acute and chronic
complications, and the introduction of chemoprophylaxis against important opportunistic pathogens. The second decade
of the epidemic has witnessed extraordinary progress in developing highly active antiretroviral therapies (HAART) as
well as continuing progress in preventing and treating individual OIs. HAART has reduced the incidence of OIs and
extended life substantially (14-16). HAART is the most effective approach to preventing OIs and should be considered
for all HIV-infected persons who qualify for such therapy (14-16). However, some patients are not ready or able to take
HAART, and others have tried HAART regimens, but therapy has failed. Such patients will benefit from prophylaxis
against OIs (15). In addition, prophylaxis against specific OIs continues to provide survival benefits even among persons
who are receiving HAART (15).
Antiretroviral therapy for treatment of Human Immunodeficiency Virus type 1 (HIV-1) infection has improved steadily since the advent of combinationtherapy in 1996. More recently, new drugs havebeenapproved, offering added dosingconvenience and improved safety profiles, while some previouslypopular drugs are being used less often as their drawbacks becomebetter defined. Resistancetesting isused more commonly in clinical practiceand interactions among antiretroviral agents and with other drugs have becomemore complex.
The Panel on Clinical Practices for Treatment of HIV (the Panel) develops these guidelines which outline current understandingof how clinicians should use antiretroviral drugs totreat adult and adolescents withHIV infections. The Panel considers new evidence and adjusts recommendations accordingly. The primary areas of attention and revision have included: whento initiate therapy, which drug combinations are preferred and which drugs or combinations should be avoided, and means tocontinue clinical benefit in the faceof antiretroviral drugresistance. In contrast, someaspects of therapy, while important, have seenless rapid dataevolution and thusfewer changes,such as medication adherence. Yet other topics have warranted more in-depth attention byseparate guidelines groups, like thetreatment of HIV during pregnancy.