ABSTRACT
With the rapid scale up of antiretroviral therapy, there is a dramatic decline in HIV related morbidity and mortality in both developed and developing countries. Several new safe antiretroviral, and newer class of drugs and monitoring assays are developed recently. As a result the treatment guideline for the management of HIV disease continue to change. This review focuses on evolving science on Indian policy - antiretroviral therapy initiation, which drugs to start with, when to change the initial regimen and what to change.
Subject(s)
Anti-HIV Agents/adverse effects , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active/methods , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , India/epidemiologySubject(s)
AIDS-Related Opportunistic Infections/drug therapy , Adolescent , Adult , Algorithms , Anti-HIV Agents/adverse effects , CD4 Lymphocyte Count , Developing Countries , Drug Resistance, Viral , Drug Therapy, Combination , Evidence-Based Medicine , Female , HIV Infections/classification , HIV-1/drug effects , Humans , India , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Male , Pregnancy , Reverse Transcriptase Inhibitors/adverse effects , Treatment Refusal , Viral LoadABSTRACT
HIV management is currently in an era of effective, potent antiretroviral therapy. Modern drug discovery and development have transformed HIV-1 disease into a treatable, chronic infectious disease. Complete suppression of viral replication is critical for long-term durability of antiretroviral therapy. Partial suppression, even at very low levels, is likely to lead to virologic failure and ultimately to the appearance of drug resistance. The relationship between adherence and resistance to HIV antiretroviral therapy is more complex than to state 'non-adherence increases the risk of drug resistance.' In many patients who fail to respond to initial therapy, the primary reason for failure is their inability to take the prescribed drug regimen or nonadherence.
Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Anti-Retroviral Agents/administration & dosage , Drug Resistance, Viral , HIV-1 , Humans , Patient Compliance , Reverse Transcriptase Inhibitors/administration & dosage , Treatment FailureABSTRACT
PURPOSE: To study the various changes in the course of cytomegalovirus (CMV) retinitis following combination antiretroviral treatment. METHODS: Combination antiretroviral treatment was given to 12 patients with active CMV retinitis following which all anti-CMV medications were discontinued once the CD4 cell counts were > 100/mm3 for 3 months. RESULTS: The median CD4 cell count increased from 36.5/mm3 (range, 3-74/mm3) at baseline to 175.5/mm3 (range, 97-410/mm3) at 3 months. No patient had reactivation of CMV retinitis or developed extraocular CMV infection during median follow-up of 16.7 months. In one patient with peripheral active CMV retinitis, the retinitis resolved completely and remained so throughout the follow-up period without specific anti-CMV treatment. Five (41.7%) patients had immune recovery vitritis. CONCLUSION: Patients receiving combination antiretroviral treatment following treatment for CMV retinitis have better control of CMV retinitis but immune recovery vitritis is a common sequelae. Reactivation of CMV retinitis is common in patients who discontinue combination antiretroviral treatment.