- Ongoing HIV replication leads to immune system damage, progression to AIDS, and systemic immune activation.
- 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.
- Maximal suppression of viral replication is a goal of therapy; the greater the suppression, the less likely the appearance of drug-resistant quasispecies.
- 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.
- The antiretroviral drugs used in combination regimens should be used according to optimum schedules and dosages.
- The number of available drugs is limited. Any decisions on antiretroviral therapy have a long-term impact on future options for the pt.
- Women should receive optimal antiretroviral therapy regardless of pregnancy status.
- The same principles apply to children and adults. The treatment of HIV-infected children involves unique pharmacologic, virologic, and immunologic considerations.
- 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.
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