ITEMS IN AFP WITH MESH TERM:
ABSTRACT: In 1996 a panel of experts convened by the International AIDS Society-USA issued new guidelines for treating human immunodeficiency virus (HIV) infection, which have recently been updated. Quantitative plasma HIV-1 RNA concentration (viral load) and CD4+ lymphocyte levels are used to monitor disease progression, determine the need to initiate antiretroviral treatment, monitor effectiveness of treatment and evaluate the need to change medications. Multi-drug therapy with nucleoside analogs, nonnucleoside reverse transcriptase inhibitors and protease inhibitors can result in measurable improvement in clinical outcome in HIV-1 infected patients.
ABSTRACT: The primary goal of antiretroviral therapy for human immunodeficiency virus (HIV) infection is suppression of viral replication. Evidence indicates that the optimal way to achieve this goal is by initiating combination therapy with two or more antiretroviral agents. The agents now licensed in the United States for use in combination therapy include five nucleoside analog reverse transcriptase inhibitors (zidovudine, didanosine, zalcitabine, stavudine and lamivudine), two nonnucleoside reverse transcriptase inhibitors (delavirdine and nevirapine) and four protease inhibitors (saquinavir, ritonavir, indinavir and nelfinavir). Current recommendations suggest that antiretroviral therapy be considered in any patient with a viral load higher than 5,000 to 20,000 copies per mL, regardless of the CD4+ count. Selection of the combination regimen must take into account the patient's prior history of antiretroviral use, the side effects of these agents and drug-drug interactions that occur among these agents and with other drugs as well. Because of the potential for viral resistance, nonnucleoside reverse transcriptase inhibitors and protease inhibitors should only be used in combination therapy. Antiretroviral agents are rapidly being developed and approved, so physicians must make increasingly complex treatment decisions about medications with which they may be unfamiliar.
Recommendations for the Use of Antiretroviral Drugs in Pregnant Women Infected with HIV - Special Medical Reports
U.S. Public Health Service Updates Guidelines for HIV Prophylaxis in Health Care Workers - Special Medical Reports
The Changing Spectrum of HIV Care - Medicine and Society
Clinical Briefs - Clinical Briefs
Newsletter - AAFP News: AFP Edition
Conference Highlights - Conference Highlights
My Needlestick - Resident and Student Voice
ABSTRACT: The diagnosis of acute human immunodeficiency virus (HIV) syndrome requires a high index of suspicion and proper laboratory testing. Patients with the syndrome may have fever, fatigue, rash, pharyngitis or other symptoms. Primary HIV infection should be considered in any patient with possible HIV exposure who presents with fever of unknown cause. The diagnosis is based on a positive HIV-1 RNA level (more than 50,000 copies per mL) in the absence of a positive enzyme-linked immunosorbent antibody assay (ELISA) and confirmatory Western blot antibody test for HIV. Early diagnosis permits patient education as well as treatment that may delay disease progression. Triple-combination antiretroviral therapy should be started immediately and continued indefinitely. Compliance with medication regimens is essential to maximize benefit and discourage the development of viral resistance.