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Table 105-3

Principles of Therapy of HIV Infection

  1. Ongoing HIV replication leads to immune system damage and progression to AIDS.
  2. Plasma HIV RNA levels indicate the magnitude of HIV replication and the rate of CD4+ T cell destruction. CD4+ T cell counts indicate the current level of competence of the immune system.
  3. Rates of disease progression differ among individuals, and treatment decisions should be individualized based on plasma HIV RNA levels and CD4+ T cell counts.
  4. Maximal suppression of viral replication is a goal of therapy; the greater the suppression the less likely the appearance of drug-resistant quasispecies.
  5. The most effective therapeutic strategies involve the simultaneous initiation of combinations of effective anti-HIV drugs with which the pt has not been previously treated and that are not cross-resistant with antiretroviral agents that the pt has already received.
  6. The antiretroviral drugs used in combination regimens should be used according to optimum schedules and dosages.
  7. The number of available drugs is limited. Any decisions on antiretroviral therapy have a long-term impact on future options for the pt.
  8. Women should receive optimal antiretroviral therapy regardless of pregnancy status.
  9. The same principles apply to children and adults. The treatment of HIV-infected children involves unique pharmacologic, virologic, and immunologic considerations.
  10. 10. Compliance is an important part of ensuring maximal effect from a given regimen. The simpler the regimen, the easier it is for the pt to be compliant.

Source: Modified from Principles of Therapy of HIV Infection, USPHS, and the Henry J. Kaiser Family Foundation.