Revised treatment guidelines have been published by the French Ministry of Health. Key points include:
- Mandatory anonymous reporting of HIV diagnoses to enable better monitoring
- The aim of treatment is to reduce viral load as low as possible for as long as possible; the newest test have a detection limit of 50 copies.
- PI-containing regimens continue to be preferrred. There is better evidence for starting therapy with a PI-containing regimen than an NNRTI-containing regimen, state the guidelines.
- Therapeutic drug monitoring should be carried out soon after commencing a PI-containing regimen to check that adequate drug levels are being achieved. It may also be utilised to determine whether very high drug levels are responsible for side effects, and to assist dosage adjustment where drug interactions might occur.
- Viral load should be tested one month after commencing or switching a regimen.
- Resistance testing is recommended to assist decisions about switching therapy, and genotypic testing of seroconverters prior to commencing treatment is recommended.
- Interleukin-2 should be made available where individuals with undetectable viral load still have restricted immune restoration (CD4 count less than 200).
- Primary prophylaxis may be discontinued when the CD4 count has remained above 200 for more than 6 months and the CD4 percentage is greater than 15%. Secondary prophylaxis for PCP and other OIs may be discontinued according to the same criteria. Secondary prophylaxis for CMV retinitis may be discontinued when the CD4 count has remained above 100 for at least six months.
- Lipids and glucose levels should be measured before commencing treatment and on a regular basis thereafter, and all individuals should also receive dietary counselling.
The full guidelines are available in pdf format from the French Ministry of Health.