The guidelines identify the most potent, effective and feasible first-line, second-line and subsequent treatment regimens, applicable to the majority of populations, the optimal timing of ART initiation and improved criteria for ART switching, and introduce the concept of third-line antiretroviral regimens. The primary audiences are national treatment advisory boards, partners implementing HIV care and treatment, and organizations providing technical and financial support to HIV care and treatment programmes in resource-limited settings. It is critical that national ART programme and public health leaders consider these recommendations in the context of countries' HIV epidemics, the strengths and weaknesses of health systems, and the availability of financial, human and other essential resources. In adapting these guidelines, care must be exercised to avoid undermining current treatment programmes, to protect access for the most at-risk populations, to achieve the greatest impact for the greatest number of people and to ensure sustainability. It is similarly important to ensure that the adaptation of these guidelines do not stifle ongoing or planned research, since the new recommendations reflect the current state of knowledge and new information for sustainability and future modifications of existing guidelines will be needed.

NPIN 21131: This report contains revised guidelines for the use of antiretroviral drugs in HIV-positive adults and adolescents that were developed by the Panel on Clinical Practices for the Treatment of HIV infection for the U.S. Department of Health and Human Services. These guidelines are based on feedback received during the 30-day comment period and further discussion among the panel members. The guidelines are intended for use by physicians and other health care providers and serves as a companion document to the therapeutic principles formulated by the National Institutes of Health Panel to Define Principles of Therapy of HIV infection. The report addresses the use of testing for plasma HIV RNA levels and CD4 T-cell counts, considerations for when to initiate therapy in established HIV infection, special considerations for therapy in patients with advanced stage disease, interruption of therapy, considerations for changing therapy and available therapeutic options, the treatment of acute HIV infection, considerations for antiretroviral therapy in adolescents, and considerations for antiretroviral therapy in pregnant women. The report is available in both English and Spanish.