Care of Patients With HIV Infection: Antiretroviral Drug Regimens.
The advent of combination antiretroviral drug regimens has transformed HIV infection from a fatal illness into a manageable chronic condition. All patients with HIV infection should be considered for antiretroviral therapy, regardless of CD4 count or HIV viral load, for individual benefit and to prevent HIV transmission. Antiretroviral drugs affect HIV in several ways: entry inhibitors block HIV entry into CD4 T cells; nucleotide and nucleoside reverse transcriptase inhibitors prevent reverse transcription from RNA to DNA via chain-terminating proteins; nonnucleoside reverse transcriptase inhibitors prevent reverse transcription through enzymatic inhibition; integrase strand transfer inhibitors block integration of viral DNA into cellular DNA; protease inhibitors block maturation and production of the virus. Current guidelines recommend six combination regimens for initial therapy. Five are based on tenofovir and emtricitabine; the other uses abacavir and lamivudine. Five include integrase strand transfer inhibitors. HIV specialists should assist with treating patients with complicated HIV infection, including patients with treatment-resistant HIV infection, coinfection with hepatitis B or C virus, pregnancy, childhood infections, severe opportunistic infections, complex drug interactions, significant drug toxicity, or comorbidities. Family physicians can treat most patients with HIV infection effectively by choosing appropriate treatment regimens, monitoring patients closely, and retaining patients in care.
Family Health Center of Worcester, 26 Queen St., Worcester, MA 01610.
Philip
P
Bolduc
Family Health Center of Worcester, 26 Queen St., Worcester, MA 01610.
Navid
N
Roder
Family Health Center of Worcester, 26 Queen St., Worcester, MA 01610.
Emily
E
Colgate
University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01655.
Sarah H
SH
Cheeseman
D023241:Antiretroviral Therapy, Highly Active; D015224:Dideoxynucleosides / Q000627:therapeutic use; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D000068679:Emtricitabine / Q000627:therapeutic use; D023581:HIV Fusion Inhibitors / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy*; D019428:HIV Integrase Inhibitors / Q000627:therapeutic use*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D000068698:Tenofovir / Q000627:therapeutic use; D000099227:Abacavir
D015224:Dideoxynucleosides; D004338:Drug Combinations; D000068679:Emtricitabine; D023581:HIV Fusion Inhibitors; D019428:HIV Integrase Inhibitors; D017320:HIV Protease Inhibitors; D019259:Lamivudine; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D000099227:Abacavir