Professional paper
Initial Therapy of Human Immunodefi ciency Virus Infection in 2009
Josip Begovac
Vanja Romih
Abstract
The treatment of human immunodeficiency virus (HIV) infections is still effective after more than a decade of antiretroviral drug usage. Current guidelines recommend the earlier initiation of treatment despite the fact that there is no such evidence from a randomized clinical trial. However, many observational studies and data from the SMART study showed significant morbidity and mortality rates in asymptomatic patients with CD4+ lymphocyte T counts between 200 and 350 per mm3. Additionally, there is an association between uncontrolled HIV replication, immune activation and non-AIDS morbidity and mortality. Guidelines from developed countries are recommending an individual approach to treatment initiation whereas the World Health organization (WHO) endorses a public health approach (with defined combinations for the first and second line regimens). In Croatia we are implementing an individual approach, but with limited choices of treatment options compared to developed countries. Most guidelines recommend to initiate the treatment with a combination of nucleoside(tide) analogues such as tenofovir/emtricitabine or abacavir/lamivudine. According to some guidelines, the initiation of treatment with non nucleoside analogues is preferred; however, the majority of guidelines have no clear preference between the classes of non-nucleoside analogues and protease inhibitors. The majority of guidelines prefer efavirenz to nevirapine. Protease inhibitors are only given with low-dose ritonavir. Most guidelines recommend a number of protease inhibitors: atazanavir, fosamprenavir, darunavir, lopinavir and saquinavir.
Keywords
HIV; therapy; antiretroviral drugs
Hrčak ID:
48270
URI
Publication date:
19.2.2009.
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