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AIDS Res Ther. 2015 Apr 24;12:12. doi: 10.1186/s12981-015-0053-z. eCollection 2015.

Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2014, Thailand.

Author information

1
Department of Medicine, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000 Thailand.
2
Bureau of AIDS, TB, and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
3
National Health Security Office, Bangkok, Thailand.
4
Thai AIDS Society, Bangkok, Thailand.
5
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
6
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
7
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
8
Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
9
Department of Preventive Medicine, Faculty of Medicine Srinakharinwirot University, Nakornnayok, Thailand.
10
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
11
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
12
Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand.

Abstract

New evidence has emerged regarding when to commence antiretroviral therapy (ART), optimal treatment regimens, management of HIV co-infection with opportunistic infections, and management of ART failure. The 2014 guidelines were developed by the collaborations of the Department of Disease Control, Ministry of Public Health (MOPH) and the Thai AIDS Society (TAS). One of the major changes in the guidelines included recommending to initiating ART irrespective of CD4 cell count. However, it is with an emphasis that commencing HAART at CD4 cell count above 500 cell/mm(3) is for public health, in term of preventing HIV transmission and personal benefit. In tuberculosis co-infected patients with CD4 cell counts ≤50 cells/mm(3) or with CD4 cell counts >50 cells/mm(3) who have severe clinical disease, ART should be initiated within 2 weeks of starting tuberculosis treatment. The preferred initial ART regimen in treatment naïve patients is efavirenz combined with tenofovir and emtricitabine or lamivudine. Plasma HIV viral load assessment should be done twice a year until achieving undetectable results; and will then be monitored once a year. CD4 cell count should be monitored every 6 months until CD4 cell count ≥350 cells/mm(3) and with plasma HIV viral load <50 copies/mL; then it should be monitored once a year afterward. HIV drug resistance genotypic test is indicated when plasma HIV viral load >1,000 copies/mL while on ART. Ritonavir-boosted lopinavir or atazanavir in combination with optimized two nucleoside-analogue reverse transcriptase inhibitors is recommended after initial ART regimen failure. Long-term ART-related safety monitoring has also been included in the guidelines.

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