Management of advanced HIV disease with no other complications in women and in Africans.
The number of patients who present with advanced human immunodeficiency virus (HIV) disease [defined as a helper lymphocyte (CD4) count <50 cells/mm3 or the presence of an acquired immunodeficiency syndrome (AIDS)-defining illness] is increasing. In the USA during 1994-1999, a relatively stable proportion of 43% of people diagnosed with HIV infection were tested late in the infection (had AIDS diagnosed within 1 year of diagnosis). A recent review of newly diagnosed infections in 2003 found that 301/977 (31%) of patients in the UK and Ireland presented late (<200 CD4 cells/mm3). Before a diagnosis is made, patients with advanced disease do not benefit from antiretroviral therapy and may continue to transmit the infection to others. Furthermore, when antiretroviral therapy is initiated in patients with CD4 counts of 201-350 cells/mm(3), the risk of death is lower than when treatment is started at lower CD4 cell counts. With the increasing prevalence of HIV in women and African immigrants, some doctors are concerned that different management approaches need to be used in these groups. This article reviews the evidence and some clinical scenarios for patients with advanced disease without complications and women and Africans who may present with advanced HIV disease. The aim is to offer practical advice on therapeutic options for treatment-naïve patients who present with advanced HIV disease on the basis of available clinical evidence.
Williams
I
I
Centre for Sexual Health and HIV Research, Royal Free and University College Medical School, London, UK. iwilliams@gum.ucl.ac.uk
Churchill
D
D
D000349:Africa / Q000208:ethnology; D019380:Anti-HIV Agents; D023241:Antiretroviral Therapy, Highly Active; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000208:ethnology; D012737:Sex Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000208:ethnology / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000188:drug therapy / Q000208:ethnology / Q000821:virology
D019380:Anti-HIV Agents