New HIV treatment guidelines, released as the International AIDS Conference in Toronto, Canada, got underway at the weekend, have the new goal of reducing viral load to undetectable levels even in treatment-experienced patients.

“Maintaining undetectable viral load is the best way to achieve long-term treatment success in HIV,” said Dr Julio Montaner, president elect of the International AIDS Society.

The guidelines indicate that newly-diagnosed patients should start treatment with a combination of three of the older antiretrovirals – including nucleoside or nucleotide reverse transcriptase inhibitors in addition to either a non-nucleoside RTI or an HIV protease inhibitor. Antiretroviral therapy should be changed when toxicity or intolerance makes it necessary or when the treatment fails.

The guidance also makes use of the more stringent 50 copies/mL plasma HIV-1 RNA threshold to define undetectable, "a goal that is now achievable in a substantial proportion of patients," according to the IAS panel charged with drawing up the new framework.

The revised recommendations are published in the August 16 issue of the Journal of the American Medical Association.