Medicus, Vol. 12 No. 2_Spolne bolesti, 2003.
Pregledni rad
Antiretroviral Treatment of Adult Patients in the 2004
Josip Begovac
Sažetak
New information and new drugs for the treatment
of human immunodeficiency virus type 1 infection have
expanded our options but also dilemmas on the choice of
drugs, onset and change of treatment. For the year 2004 we
recommend starting treatment for: 1) patients with symptomatic
HIV disease, 2) asymptomatic patients with less than
200 CD4+ cell counts per mm3 of blood, and 3) asymptomatic
patients with CD4+ cell counts between 200 and 350 per mm3
of blood, and a HIV1 RNA viral load greater than 60000 copies
per ml of plasma or a rapidly declining CD4+ cell count (more
than 80 cells per mm3 in one year). We do not recommend
treatment for asymptomatic patients with more than 350 CD4+
cells per mm3. The initial treatment should include a non-nucleoside
analogue or a boosted protease inhibitor supported by
low doses of ritonavir, with two nucleoside analogues. On the
basis of randomized controlled clinical trials performed so far,
the initial treatment of efavirenz or lopinavir/ritonavir can be
recommended. The combination of three nucleoside analogues
is not recommended for initial treatment. Treatment success is
defined by achieving a non-measurable viremia (less than 50
copies of HIV1 RNA per ml plasma). In the case of successful
treatment, the antiretroviral regimen can be modified by simpler
and less toxic combinations due to either the patient’s
wish or adverse events. In the case of initial therapy failure,
special attention should be paid to issues like compliance, HIV
virus resistance and drug pharmacokinetics. If the drug fails, it
is necessary to test HIV virus resistance to drugs and adequate
medication should be administered on the basis of this analysis.
Ključne riječi
HIV1; treatment; antiretroviral drugs
Hrčak ID:
20579
URI
Datum izdavanja:
7.10.2003.
Posjeta: 1.426 *