Resumen de Executive summary of the Consensus Document of GeSIDA and Spanish Secretariat for the National Plan on AIDS on combined antiretroviral treatment in adults infected by the human immunodeficiency virus (January 2013)
Grupo de Estudio de SIDA (GESIDA), Pere Domingo Pedrol, Rosa Polo Rodríguez, Fernando Lozano de León Naranjo, José López Aldeguer, Koldo Aguirrebengoa, Vicente Estrada Pérez, Félix Gutiérrez Rodero, Hernando Knobel, Josep Maria Llibre Codina, Celia Miralles Álvarez, José María Miró Meda, Antonio Rivero Román, Jesús Santos González, Montserrat Tuset Creus, Antonio Antela López, Víctor Asensi Álvarez, José Ramón Arribas López, José Ramón Blanco Ramos, Vicente Boix Martínez, Federico García García, José María Gatell Artigas, Josep Mallolas Masferrer, Esteban Martínez Chamorro, Santiago Moreno Guillén, Rosario Palacios Muñoz, María Jesús Pérez Elias, Juan Antonio Pineda Vergara, Francesc Vidal Marsal, Juan Berenguer Berenguer
In the present update of the guidelines, a starting combination antiretroviral treatment (cART) is recommended in symptomatic patients, in pregnant women, in serodiscordant couples with a high risk of transmission, in patients co-infected with hepatitis B virus requiring treatment, and in patients with HIV-related nephropathy. Guidelines on cART are included in the event of a concurrent diagnosis of HIV infection with an AIDS-defining event. In asymptomatic naïve patients, cART is recommended if the CD4+ lymphocyte count is <500 cells/µL; if the CD4+ lymphocyte count is >500 cells/µL, cART can be delayed, although it may be considered in patients with liver cirrhosis, chronic infection due to hepatitis C virus, high cardiovascular risk, plasma viral load (PVL) >105 copies/mL, CD4+ lymphocyte percentage <14%, cognitive impairment, and age >55 years. cART in naïve patients requires a combination of 3 drugs, and its aim is to achieve undetectable PVL. Treatment adherence plays a key role in sustaining a favorable response. cART can, and should be, changed if virological failure occurs, in order to return to undetectable PVL. Approaches to cART in acute HIV infection, in women, in pregnancy, in tuberculosis, and post-exposure prophylaxis are also examined.
