Initiation of antiretroviral therapy: implications of recent findings.

Academic Article

Abstract

  • A number of reports related to initiation of antiretroviral therapy have been reported recently. Available data continue to support the practice of not starting therapy for asymptomatic patients who have CD4+ cell counts above 350/mL, and consideration for initiating antiretroviral therapy below this point, but before the count drops to 200/mL. In terms of initial regimens, some data suggest better virologic response rates with nonnucleoside reverse transcriptase inhibitors (NNRTI)-based regimens than with protease inhibitor-based regimens. The differences are likely due to better tolerability of NNRTI-based regimens. Small studies in treatment-naive patients have shown poor virologic outcome in patients receiving certain regimens, such as abacavir/lamivudine/tenofovir or didanosine/lamivudine/tenofovir. These findings appear to be explained by the differing effects of the reverse transcriptase K65R mutation on different drugs. Other recent studies suggest fewer metabolic adverse effects with emtricitabine-containing treatment than with stavudine-containing treatment, comparable virologic outcomes with once-daily and twice-daily abacavir regimens; comparable virologic outcomes with once-daily and twice-daily lopinavir/ritonavir regimens, and an association between didanosine 400 mg/tenofovir regimens and declines in CD4+ cell counts despite viral suppression. This article summarizes a presentation on initiation of antiretroviral therapy by Michael S. Saag, MD, at International AIDS Society-UsA course in New York in March 2004.
  • Published In

    Keywords

  • Acquired Immunodeficiency Syndrome, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Female, HIV Infections, Humans, Male, Prognosis, Randomized Controlled Trials as Topic, Reverse Transcriptase Inhibitors, Severity of Illness Index, Survival Analysis, Treatment Outcome, Viral Load
  • Author List

  • Saag MS
  • Start Page

  • 83
  • End Page

  • 88
  • Volume

  • 12
  • Issue

  • 3