Antiretroviral therapy in adults infected with HIV
Terapia antirretroviral en adultos infectados por VIH
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Abstract
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.
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