Initiation of antiretroviral therapy: implications of recent findings.
A number of reports related to initiation of antiretroviral therapy have been reported recently. Available data continue to support the practice of not starting therapy for asymptomatic patients who have CD4+ cell counts above 350/mL, and consideration for initiating antiretroviral therapy below this point, but before the count drops to 200/mL. In terms of initial regimens, some data suggest better virologic response rates with nonnucleoside reverse transcriptase inhibitors (NNRTI)-based regimens than with protease inhibitor-based regimens. The differences are likely due to better tolerability of NNRTI-based regimens. Small studies in treatment-naive patients have shown poor virologic outcome in patients receiving certain regimens, such as abacavir/lamivudine/tenofovir or didanosine/lamivudine/tenofovir. These findings appear to be explained by the differing effects of the reverse transcriptase K65R mutation on different drugs. Other recent studies suggest fewer metabolic adverse effects with emtricitabine-containing treatment than with stavudine-containing treatment, comparable virologic outcomes with once-daily and twice-daily abacavir regimens; comparable virologic outcomes with once-daily and twice-daily lopinavir/ritonavir regimens, and an association between didanosine 400 mg/tenofovir regimens and declines in CD4+ cell counts despite viral suppression. This article summarizes a presentation on initiation of antiretroviral therapy by Michael S. Saag, MD, at International AIDS Society-UsA course in New York in March 2004.
Saag
Michael S
MS
University of Alabama at Birmingham, Birmingham, Alabama, USA.
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors