Executive summary. Documento de consenso de Gesida/Plan Nacional sobre el Sida respecto al tratamiento antirretroviral en adultos infectados por el virus de la inmunodeficiencia humana (Actualización enero 2012)

In the present update of the guidelines, starting antiretroviral treatment is recommended in symptomatic patients, in pregnant women, in sero-discordant couples with high transmission risk, in patients co-infected with hepatitis B requiring treatment and in patients with HIV-related nephropathy. Guidelines on combined antiretroviral treatment (cART) are included in the event of concurrent HIV infection diagnosis with an AIDS-defining event. In asymptomatic naive patients, cART will be based on CD4 lymphocyte count, plasma viral load (VL), patient age and patient comorbidity: (i) cART is recommended if CD4 count is lower than 350cells/µL; (ii) cART is equally recommended if CD4 count is between 350 and 500cells/µL and may only be deferred in the event of patient refusal with stable CD4 count and low VL; (iii) if CD4 count is higher than 500cells/µL cART can be delayed, but it may be considered in patients with liver cirrhosis, chronic virus C hepatitis, high cardiovascular risk, VL >105copies/mL, CD4 proportion lower than 14% and age over 55 years. cART in naive patients requires a combination of three drugs and its aim is to achieve undetectable VL. Treatment adherence plays a basic role in sustaining good response. cART could and should be changed if virologic failure occurs in order to achieve undetectable VL again. Approaches to cART in HIV acute infection, in women and pregnancy and post exposure prophylaxis are also commented on