ARV - Supplement Guidelines for Using Antiretroviral Agents...

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Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents The Panel on Clinical Practices for Treatment of HIV * Prepared by Mark Dybul, MD; Anthony S. Fauci, MD; John G. Bartlett, MD; Jonathan E. Kaplan, MD; and Alice K. Pau, PharmD Summary The availability of an increasing number of antiretroviral agents and the rapid evolution of new information have intro- duced substantial complexity into treatment regimens for persons infected with human immunodeficiency virus (HIV). In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for clinical management of HIV-infected adults and adolescents (CDC. Report of the NIH Panel To Define Principles of Therapy of HIV Infection and Guide- lines for the use of antiretroviral agents in HIV-infected adults and adolescents. MMWR. 1998;47[RR-5]:1-41). This report, which up- dates the 1998 guidelines, addresses 1) using testing for plasma HIV ribonucleic acid levels (i.e., viral load) and CD4 ± Tce l lcount ; 2) using testing for antiretroviral drug resistance; 3) considerations for when to initiate therapy; 4) adherence to antiretroviral therapy; 5) considerations for therapy among patients with advanced dis- ease; 6) therapy-related adverse events; 7) interruption of therapy; 8) considerations for changing therapy and available therapeutic options; 9) treatment for acute HIV infection; 10) considerations for antiretroviral therapy among adolescents; 11) considerations for antiretroviral therapy among pregnant women; and 12) concerns related to transmission of HIV to others. Antiretroviral regimens are complex, have serious side effects, pose difficulty with adherence, and carry serious potential conse- quences from the development of viral resistance because of non- adherence to the drug regimen or suboptimal levels of antiretro- viral agents. Patient education and involvement in therapeutic decisions are critical. Treatment should usually be offered to all patients with symptoms ascribed to HIV infection. Recommenda- tions for offering antiretroviral therapy among asymptomatic pa- tients require analysis of real and potential risks and benefits. In general, treatment should be offered to persons who have ² 350 CD4 ± l ls/mm 3 or plasma HIV ribonucleic acid (RNA) levels of ³ 55,000 copies/mL (by b-deoxyribonucleic acid [bDNA] or reverse transcriptase-polymerase chain reaction [RT-PCR] assays). The rec- ommendation to treat asymptomatic patients should be based on the willingness and readiness of the person to begin therapy; the degree of existing immunodeficiency as determined by the CD4 ± T cell count; the risk for disease progression as determined by the CD4 ± l lcoun tandleve lo fp la smaH IVRNA ;thepo ten t ia l benefits and risks of initiating therapy in an asymptomatic person; and the likelihood, after counseling and education, of adherence to the prescribed treatment regimen.
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This note was uploaded on 02/13/2011 for the course BIO 228 taught by Professor Murphy during the Fall '10 term at Gustavus.

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ARV - Supplement Guidelines for Using Antiretroviral Agents...

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