Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- Part XII HIV
- 96 HIV Infection: Initial Evaluation and Monitoring
- 97 HIV-1 Infection: Antiretroviral Therapy
- 98 Immune Reconstitution Inflammatory Syndrome
- 99 Differential Diagnosis and Management of Opportunistic Infections Complicating HIV Infection
- 100 Prophylaxis of Opportunistic Infections in HIV Infection
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
97 - HIV-1 Infection: Antiretroviral Therapy
from Part XII - HIV
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- Part XII HIV
- 96 HIV Infection: Initial Evaluation and Monitoring
- 97 HIV-1 Infection: Antiretroviral Therapy
- 98 Immune Reconstitution Inflammatory Syndrome
- 99 Differential Diagnosis and Management of Opportunistic Infections Complicating HIV Infection
- 100 Prophylaxis of Opportunistic Infections in HIV Infection
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
Summary
Significant progress has been made in the management of HIV-1 disease since 1987, when the first antiretroviral agent, zidovudine, was released. Four classes of antiretrovirals are currently used for the treatment of HIV-1: nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and fusion inhibitors (FIs). A combination of two NRTIs with one NNRTI or PI comprises the standard antiretroviral treatment regimen, also known as highly active antiretroviral therapy (HAART). As of the beginning of 2007, 22 agents have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of HIV-1 (Table 97.1). The goal of antiretroviral treatment is to achieve maximal viral suppression and thus preserve the immune function of the patient and delay the clinical progression of HIV-1 disease. Treating HIV-infected patients requires commitment from both the caregiver and the patient, perpetual counseling and support, and judicial use of the available diagnostic and therapeutic tools by the clinician. Measurement of plasma HIV-1 RNA levels (viral load, VL) and CD4+ cell count is routinely used to monitor therapy. With the new ultrasensitive polymerase chain reaction (PCR) methods, reliable detection of 50 viral copies/mL or more can be accomplished. Failure to achieve undetectable levels of plasma HIV-1 RNA may suggest incomplete compliance, drug resistance, or unfavorable pharmacokinetics.
In this chapter the following topics are discussed: treatment initiation, antiretroviral drugs, recommended first-line antiretroviral regimens, and management of HIV infection during pregnancy.
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- Chapter
- Information
- Clinical Infectious Disease , pp. 689 - 698Publisher: Cambridge University PressPrint publication year: 2008