Hepatitis in the New IAS-USA Panel Antiretroviral Treatment Guidelines

The newly released International AIDS Society 2010 guidelines for antiretroviral treatment of adults with HIV infection (Thompson, et al. JAMA. 2010; 304:321-33) represents an important step for setting up the optimal management of HIV-infected persons at a time when new, more potent and safer antiretroviral agents have become available and when the deleterious impact of inflammatory processes associated to uncontrolled HIV replication regardless of CD4 counts have been fully appreciated. Moreover, given the accelerated course of liver disease in the subset of HIV-infected patients with chronic viral hepatitis, the panel agreed to recommend earlier initiation of antiretroviral therapy in most coinfected individuals. Three aspects, however, merit some consideration.