New version of the antiretroviral therapy guidelines
The team at the International AIDS Society (USA) has updated the previous version of the antiretroviral therapy guidelines for people with HIV infection in adults according to the latest scientific achievements.
The recommendations for antiretroviral therapy are of great importance, given all the difficulties in this area and the various clinical situations in which antiretroviral drugs are used. The International AIDS Society (USA) team has updated the previous version of the recommendations according to the latest scientific achievements. The aim of this work was to create a manual for doctors providing assistance to people infected with HIV on the use of antiretroviral drugs in the context of relatively unlimited access to drugs and methods of examination. However, the basic principles described in the recommendations can be used in resource-limited environments.
The work was carried out by a group of 16 specialists at no cost. The data published or presented at certain scientific conferences from mid-2004 to May 2006 were studied by each member of the group. The data were selected on the basis of which it was possible to make modifications to the existing recommendations. The new version of the recommendations has been checked by the entire group of specialists.
Much attention is paid to 4 main questions: when to start antiretroviral therapy, with which drugs to start, when to change therapy, and to which drugs to switch. Antiretroviral therapy for certain groups of people infected with HIV, such as adolescents, drug users, pregnant women, patients infected with hepatitis B or C and people with tuberculosis, is also discussed.
Antiretroviral therapy in adult patients is undergoing rapid change, making it difficult to select therapies that meet the latest achievements. The initiation of treatment is recommended for all patients with symptoms of the disease, patients with an asymptomatic course with a decrease in CD4 + T lymphocyte count less than 200 in 1 μl, and should also be offered to patients with asymptomatic evolution with a decrease in CD4 + T lymphocytes less than 350 in 1 μl.
The start of treatment is selected taking into account the individual characteristics of the patient. It should include a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor, the effect of which is enhanced by a low dose of ritonavir, in combination with 2 nucleoside (or nucleotide) inhibitors of reverse transcriptase.
A change in treatment is carried out with toxicity or intolerance at the start of treatment, or with confirmation of its ineffectiveness. The currently recognized virological ineffectiveness has confirmed viral loads of HIV RNA greater than 400 copies / ml after 24 weeks, more than 50 copies / ml after 48 weeks or a repeated increase in the level of HIV RNA greater than 400 copies / ml after a previous decrease of less than 400 copies / ml.
Particular attention should be paid to the short- and long-term commitment of patients to antiretroviral therapy, which are essential to the success of treatment.