Management of HIV-infected adults: antiretroviral treatment.
(1) The main aim of antiretroviral therapy is to inhibit viral replication as fully and as durably as possible.  The reference treatment is currently a regimen combining three antiretroviral drugs belonging to two different classes.  (2) Viral load and the CD4+ lymphocyte count are the best available markers for follow-up and decision-making.  (3) Viral resistance, along with frequent cross-resistance within a given class of antiretroviral drugs, limits the therapeutic options.  (4) Adherence to treatment is of major importance.  Prescription of antiretroviral drugs must be part of a "treatment plan" decided with and accepted by the patient.  (5) First-line treatment and subsequent modifications are based mainly on viral load values.  A confirmed rebound of viral replication necessitates a rapid switch in treatment. (6) Viral load rebounds should be managed with antiretroviral drugs that the patient has not yet received and to which no cross-resistance is expected.  (7) After repeated treatment failure, T cell counts are more useful and important than viral load values.  It may be better to continue the ongoing treatment unchanged than to partially modify it.  (8) Treatment success depends partly on the patient's social environment and quality of care.
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D019468:Disease Management; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016896:Treatment Outcome