• Combination therapy is now standard best practice.
• Measurement of HIV-RNA viral load should be used to monitor risk of clinical progression, and to gauge effectiveness of therapy.
• Treatment is recommended when the patient is symptomatic, and when plasma HIV-RNA values exceed 5000-30 000 copies/mL, or when CD4 count is below 500 x 106 cells/L.
• With mild to moderate immunodeficiency, treatment should be initiated with a two-drug combination of nucleoside RT inhibitors (e.g. AZT/DDC, AZT/3TC, D4T/3TC) or with 2 nucleoside and 1 non-nucleoside RT inhibitor (e.g. AZT/DDI/nevirapine).
• With moderate to severe immunosuppression or high viral loads, a three-drug combination (including a protease inhibitor) should be used.
• A change in treatment should be considered when the viral load returns to within 70% (0.5 log) of pretreatment values, or when there is a consistent fall in CD4 count, or when new symptoms develop.
• A new regimen should include one or more (preferably two) new drugs that the patient has not previously used, and that are not cross resistant with the previous drugs.
Reproduced with permission 8
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