1

Explanation of gradingThe recommendations regarding treatment initiation were graded as follows:

Grading Explanation

„Indicated“ Treatment is indicated

„should be initiated“ Treatment is generally indicated, but waiting is justifiable

„may be initiated“ Treatment is generally not indicated, but treatment initiation is justifiable

„not indicated“ Treatment is not indicated

The recommendations regarding choice of drugs were graded as follows:

Grading Explanation

„recommended“ Preferable Drug / combination

„alternative“ May be given, could be the best choice for some patients

„not recommended“ Only in special cases, but remains justifiable

„not indicated“ Should not be given

2

Symptoms CD4+ T-cells/µl

Additional criteria*

ART

HIV-associated symptoms and diseases(CDC: C, B), HIVAN, HAND

Any value-

Indicated

Asymptomatic (CDC: A)

<350 - indicated

350-500

Fulfilled indicated

- May be initiated

>500

Fulfilled should be initiated

Not fulfilled May be initiated

Acute retroviral syndrome with prolonged / severe symptoms

Any value - should be initiated

Asymptomatic/ mild symptoms during serokonversion

Any value - May be initiated

Treatment initiation

3

*Additional criteria for treatment initiation

• Pregnancy• Reduction of Infectiousness• Higher age• Chronic Hepatitis B and C Coinfection• Rapidly decreasing CD4+ cell count• Plasma viremia >100.000 copies/mL

• See: „Additional Aspects“:• High cardiovascular Risk (Framingham Score >20%/10 Yrs)

4

1 only for HLA-B*5701-negatives; Cave: possibly elevated cardiovascular risk, virologically slightly inferior leicht unterlegen

3 Cave: hepatotoxiicity increased in men with CD4+ count >400 and women with CD4+ count >250/µL4 Cave: not if HIV-RNA >100000 c/mL (not licensed)

Choice of drugs

2 not during pregnancy and in women with a desire to have children

(Cobicistat as an alternative for boosting of ATV and DRV discussed in the text)

Nucleoside/nucleotide analogue combinationsRecommended- Tenofovir/Emtricitabine- Abacavir/Lamivudine1

Alternative- Tenofovir / Lamivudine

NNRTIRecommended- Efavirenz²- Nevirapine³- Rilpivirine4

PIRecommended- Atazanavir/r- Darunavir/r- Lopinavir/rAlternative- Fosamprenavir

INIRecommended- Dolutegravir- Raltegravir- Elvitegravir/c (+TDF/FTC)

+

Combination partner 1 Combination partner 2