Antiretroviral therapy in adults infected with HIV
Terapia antirretroviral en adultos infectados por VIH
Show authors biography
Infection with VIII is of global and local importance. Highly active antiretroviral therapy (HAART) has dramatically modified the natural history of VIII infection, making it a controllable chronic disease. In Colombia, the Compulsory Health Plan (POS) obliges the Health Provider Companies (EPS) that their members have access to HAART. The ideal time to start antiretroviral therapy is controversial. The health provider can make their decisions adapting the guidelines of the World Health Organization (WHO) or the United States Department of Health (DHHS). Currently, there is evidence of the superiority and convenience of some antiretroviral regimens over others, which has been reflected in the fact that some regimens are considered preferential and others are alternative. The selection of the initial antiretroviral regimen must take into account the best available evidence on efficacy and tolerance, but it must also consider the local conditions of the Health System that in some circumstances make the use of certain medications difficult. Once the therapy has begun, the patient should be monitored to evaluate possible adverse effects and the virological, immunological and clinical response. Changes in antiretroviral therapy should be made with caution, ideally guided by an expert in HIV management. Although viral resistance tests are a valuable instrument in the selection of drugs for patients with therapeutic failure, its technological complexity and its cost make it difficult to use it routinely in our environment. Compliance with antiretroviral therapy is probably the most important determinant of optimal response, and therefore should be explored, reinforced and, if necessary, corrected in each patient's consultation.
Abbreviations: HIV: Human Immunodeficiency Virus, AIDS: Acquired Immunodeficiency Syndrome, WHO: World Health Organization, DHHS: United States Department of Health, EPS: Healthcare Provider, NRTI: Nucleotide Transcriptase Inhibitors, NNRTI: Inhibitors No - Transcriptase Nucleotides, PI: Protease Inhibitors, AZT: Zidovudine, D4T: Stavudine, 3TC: Lamivudine, ETC: Emtricitabine, DDI: Didanosine, ABC: Abacavir.
Article visits 177 | PDF visits 2358
Downloads
1. UNAIDS/WHO. Colombia: Epidemiological fact sheet on HIV/AIDS and sexually transmitted diseases. (Citado 2002). Disponible en: PDF htpp://www.who.int/emchiv/fact sheets/pdfs/Colombia.
2. «Terapia antirretroviral». Disponible en PDF. http://aidsinfo.nih.gov/quidelines/adult/AA 032304.
3. «Terapia antirretroviral».Disponible en PDF. http://www.who.int/hiv/pub/prev care/en/arvrevisionsp.
4. Egger M, May M, Chene et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002;360(9340):1178
5. Florence E, Lundgren J, Dreezen C, et al. Factors associated with a reduced CD4 lymphocyte count response to HAART despite full viral suppression in the EuroSIDA study. HIV Medicine 2003;4(3):255-62.
6. Ahdieh-Grant L, Yamashita TE, Phair JP, et al. When to Initiate Highly Active Antiretroviral Therapy: A Cohort Approach. Am J Epidemiol 2003;157:738-46.
7. Albrecht MA, Bosch RJ, Hammer SM, et al. Nelfinavir, efavirenz, or both after the failure of nucleoside treatment of HIV infection. N Engl J Med. 2001;345(6):398-407.
8. Staszewski S, Morales-Ramirez J, Tashima KT, et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. Study 006 Team. N Engl J Med. 1999;341(25):1865-73.
9. Gulick RM, Ribaudo HJ, Shikuma CM, et al. ACTG 5095: A comparative study of 3 protease inhibitor-sparing antiretroviral regimens for the initial treatment offlIV infection. In: International AIDS Society Abstracts of the 2 nd Conference on HIV Pathogenesis and Treatment; 2003 Jul 13-16; París Francia. París 1992.Abstractno.41
10. Cozzi-Lepri A, Phillips AN,D'Arminio Monforte A, et al. Virologic and immunologic response to regimens containing nevirapine or efavirenz in combination with 2 nucleoside analogues in the Italian Cohort Naive Antiretrovirals study. J Infect Dis 2002; 185:1062-69.
11. P Keiser, N Nassar, C White, G Koen, Moreno S. Comparison of nevirapine- and efavirenz-containing antiretroviral regimens in antiretroviral-naive patients: a cohort study. HIV Clin Trials 2002; 3:296-303.
12. Van Leth F, Phanuphak P, Ruxrugtham K, et al. Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz, or both drugs, plus stavudine and lamivudine: a randomized open-label trial, the 2NN Study. Lancet 2004;363: 1253-63.
13. Walmsley S, Bernstein B, King M, et al. Lopinavir-ritonavir versus nelfinavir for the initial treatment of HIV infection. N Engl J Med 2002;346(26):2039-46.
14. Sustiva. Package insert. T4-B0001A-10-03. Princenton, NJ, Bristol-Myers Squibb Company: 2003.
15. A phase III study comparing the antiviral efficacy and safety of BMS-232632 (ATV) with efavirenz (EFV), each in combination with fixed doce zidovudine-lamivudine (ZDV+3TC).Princeton, NJ Bristol-Myers Squibb Company.
16. ACTG 384. XIV International AIDS Conference, Barcelona 2002, Abstracts LB20a and LB20b.
17. Boubaker K, Flepp M, Sudre P, et al. Hyperlactatemia and antiretroviral therapy: the Swiss HIV Cohort Study. Clin Infect Dis 2001; 33(11):1931-7.
18. New nevirapine label underscores the risk for hepatotoxicity in key populations. AIDS Clinical Care 2004;16(3):2.
19. Maggiolo F, Migliorino M, Pirali A, Pravettoni G, Caprioli S, Suter F. Duration of viral suppression in patients on stable therapy for HIV-1 infection is predicted by plasma HIV RNA level after 1 month of treatment. J Acquir Immune Defic Syndr 2000;25(1):36-43.
20. Raboud JM, Rae S, Montaner JS. Predicting HIV RNA virologic outcome at 52-weeks follow-up in antiretroviral clinical trials. The INCAS and AVANTI Study Groups. J Acquir Immune Defic Syndr 2000;24(5):433-9.
21. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21-30.
Information
Keywords
