Italian consensus statement on management of HIV-infected individuals with advanced disease naïve to antiretroviral therapy.
BACKGROUND
Individuals with advanced HIV infection naïve to antiretroviral therapy represent a special population of patients frequently encountered in clinical practice. They are at high risk of disease progression and death, and their viroimmunologic response following the initiation of highly active antiretroviral therapy may be more incomplete or slower than that of other patients. Infection management in such patients can also be complicated by underlying conditions, comorbidities, and the need for concomitant medications.


OBJECTIVE
To provide practical guidelines to those clinicians providing care to HIV-infected patients in terms of diagnostic assessment, monitoring, and treatment.


CONCLUSIONS
The principals of antiretroviral treatment in asymptomatic naïve patients with advanced HIV infection are the same as those applicable to the general population with asymptomatic HIV infection. Naïve patients with advanced HIV infection and a history of AIDS-defining illnesses urgently need antiretroviral treatment, with the choice of antiretroviral regimen and timetable based on such factors as concomitant treatment and prophylaxis, drug interactions, and potential concomitant drug toxicity. Finally, an adequate counseling program - both before and after HIV-testing - that includes aspects other than treatment adherence monitoring is a crucial step in disease management.
Antinori
A
A
Istituto Nazionale Malattie Infettive Lazzaro Spallanzani IRCCS, via Portuense 292, 00149, Rome, Italy. antinori@inmi.it
Ammassari
A
A
Torti
C
C
Marconi
P
P
Andreoni
M
M
Angarano
G
G
Bonora
S
S
Castagna
A
A
Cauda
R
R
Clerici
M
M
Monforte
A d'Arminio
Ad
De Luca
A
A
Di Perri
G
G
Galli
M
M
Girardi
E
E
Gori
A
A
Lazzarin
A
A
Lo Caputo
S
S
Mazzotta
F
F
Montella
F
F
Mussini
C
C
Perno
C F
CF
Puoti
M
M
Rizzardini
G
G
Rusconi
S
S
Vullo
V
V
Carosi
G
G
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D015897:Comorbidity; D018450:Disease Progression; D004334:Drug Administration Schedule; D006678:HIV / Q000254:growth & development; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D010349:Patient Compliance; D017410:Practice Guidelines as Topic
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents