Medication

Optimal antiretroviral therapy now depends on the use of combinations of drugs. Monotherapy is no longer accepted practice. Refer to Table 24.4 for the summary of recommendations of the drugs for use in HIV infection. Viral resistance is the limiting factor, no matter how potent an individual drug may be at reducing viral load initially. The trials of combined zidovudine and lamivudine demonstrated both a more sustained decrease in plasma viral load than either drug did alone, and a more delayed development of viral resistance. There are now many antiretroviral drugs available for use in Australia (Table 24.5) and clinicians have a much wider scope of treatments available. However, many questions remain about combination therapy and further trials using viral load as a clinical endpoint should provide pointers for treatment. Currently the use of 3 drugs is favoured. Subcutaneous injections of interleukin-2 have been shown to boost immunity.

The astute general practitioner will use the opportunity of a request for an HIV test to explore preventive and sexual health issues. A full sexual history and drug history must incorporate the three C's of counselling, confidentiality and consent in the pretest interview.

Many HIV-positive patients have described how the results left them bewildered and devastated,

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