Initiating HIV/AIDS Therapy in Treatment-Naïve Patients How do you apply the DHHS guidelines for HIV/AIDS treatment in your practice?
	Enlarged Version of Graphics Below	Announcer (VO): The most recent DHHS guidelines for the treatment of HIV infection in adults and adolescents recommend preferred regimens that are either non-nucleoside-based or PI-based. Efavirenz is the preferred anchor drug for NNRTI-based regimens. However, efavirenz-based regimens should not be used in pregnant women or in women with high pregnancy potential. Lopinavir/ritonavir is the basis for preferred PI-based regimens. Nucleosides can be used in various combinations to design effective regimen backbones.   See Slide Dr. Bellos (OC): I think that one has to look at the guidelines and realize that they are guidelines. They're not dictums of therapy. It's not as in many things we do with infectious disease. For example, a patient with an infected endocarditis most likely gets treated for four weeks, so that's pretty much standard of care. With respect to the guidelines, I think they're very helpful for clinicians to initiate decisions regarding therapy in naïve patients, and also in experienced patients. For the clinicians who have had a large amount of experience, I think the guidelines are something to fall back on, but again, that's not something I use on a daily basis in deciding therapies for patients. Dr. Kwakwa (OC): They are very relevant in today's practice, but I think that what you find is with practitioners who've been doing this over a longer time, or practitioners who may see larger numbers of patients with HIV, that they serve as mere guidelines. With people who may not see as many patients, or who may not have been doing this for a very long time, they are incredibly important to really give the structure of the treatment that they give to their patients, yes. They are incredibly important. Dr. Wohlfeiler (OC): The guidelines I think are just that. They're guidelines. It's not cookbook medicine. HIV never can be cookbook medicine. The guidelines are great because they're evidence based. And so you know where the strength of the data is out there. And that's important to making decisions. But I think that you really have to individualize regimens. You have to do things based on your own clinical experience. Dr. Bellos (OC): They are a very good, sound starting point for regimens, and again, I think in a lot of instances, the guidelines don't take into account comorbidities with patients, and I think that's an important issue in this setting, especially as the demographic of the epidemic has evolved, and we're looking at patients who have more-a higher incidence of hepatitis B or C, its treatment, as well as patients that have underlying comorbid conditions, such as diabetes, hypertension, atherosclerotic cardiovascular disease-I think those things, those comorbidities, are things that we need to be taking into consideration as we are initiating our therapy in patients.
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