On 2 earlier occasions, in 2002 and 2003, the Swedish Medical Products Agency (MPA) and the Swedish Reference Group for
Antiviral Therapy (RAV) have jointly publicized recommendations for the treatment of
HIV infection. A working group from the same expert team that produced the 2002 report has now revised the text again. Since the publication of the last treatment recommendations, 4 new medicines have become available:
emtricitabine,
atazanavir,
fosamprenavir, and enfuvirtid. The last-mentioned belongs to a new class of HIV medications called fusion inhibitors (Box 1). It is likely that
tipranavir will also be on the market soon. Simultaneously, the drug zalcitabin has been deregistered. The following updated recommendations parallel the earlier ones, but increased knowledge allows us to be more specific in our recommendations. Thus, it is now suggested that the initial treatment for
HIV infection consist of 2
nucleoside reverse transcriptase inhibitors (NRTIs) and 1 non-
nucleoside reverse transcriptase inhibitor (NNRTI); or 2 NRTIs and 1
protease inhibitor (PI). In the group of the NRTIs,
stavudine is no longer recommended for this purpose. In the NNRTI group,
efavirenz should be preferred to
nevirapine, except under special circumstances. Finally, PIs ought to be boosted with
ritonavir (PI/r). Also new are recommendations regarding treatment choices for patients co-infected with hepatitis B virus (HBV) or
tuberculosis (TB). As in the case of the previous publication, recommendations are evidence-graded in accordance with the Oxford Centre for Evidence Based Medicine, 2001 (see http://www.cebm.net/levels_of_evidence.asp#levels), and have been supplemented with references to newly-added sections and data not referred to in earlier background documentation.