HIV AIDS medical therapy: Difference between revisions

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<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
<font color="#FFF">
'''MDR Tuberculosis'''
'''Anti-retroviral Regimens'''
</font>
</font>
</div>
</div>
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<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Adults'''
&nbsp;&nbsp;▸&nbsp;&nbsp;'''NNRTI-Based Regimen'''
</font>
</font>
</div>
</div>
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<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Children'''
&nbsp;&nbsp;▸&nbsp;&nbsp;'''PI-Based Regimen'''
</font>
</font>
</div>
</div>
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| valign=top |
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|MDR-TB Adults}}
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|NNRTI-Based Regimen}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Standard Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Standard Regimen'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 1: First-line oral drugs</u>''' <br>
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |
▸ ''' [[Pyrazinamide]] 20–30 mg/kg''' <br> OR <br> ▸ '''[[Ethambutol]] 15–25 mg/kg''' <br> OR <br> ▸ '''[[Rifabutin]] 5 mg/kg'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 2: Injectable drugs</u>''' <br>
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |
▸ '''[[Capreomycin]] 15 mg/kg'''<br> OR <br> ▸ '''[[Kanamycin]] 15 mg/kg'''<br> OR <br> ▸ '''[[Amikacin]] 7.5-10 mg/kg'''<br> OR <br> ▸ '''[[Streptomycin]] 12–18 mg/kg'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 3: Fluoroquinolones</u>''' <br>
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |
▸ '''[[Levofloxacin]] 500-1000 mg'''<br> OR <br> ▸ '''[[Moxifloxacin]] 400 mg'''<br> OR <br> ▸ '''[[Ofloxacin]] 400 mg'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small>Table adapted </small>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 4:Oral bacteriostatic second-line drugs</u>''' <br>
▸ '''[[Ethionamide]] 15-20 mg/kg'''<br> OR <br> ▸ '''[[Protionamide]] 15-20 mg/kg''' <br> OR <br> ▸ '''[[Cycloserine]] 10-15 mg/kg'''<br> OR <br> ▸ '''[[Terizidone]] 10-20 mg/kg '''<br> OR <br>▸ '''[[Aminosalicylic acid|Para-aminosalicylic acid]] 8-12 g/d divided q8-12h'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small>Table adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed.<ref name="WHO 2013"> {{cite web|  url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref></small>
|}
|}
|}
|}
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| valign=top |
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|MDR-TB Children}}
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|PI-Based Regimen}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Standard Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Standard Regimen'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 1: First-line oral drugs</u>''' <br>
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |  
▸ ''' [[Pyrazinamide]] 20-30 mg/kg (Max: 600 mg)''' <br> OR <br> ▸ '''[[Ethambutol]] 15-20 mg/kg''' <br> OR <br> ▸ '''[[Rifabutin]] 5 mg/kg'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 2: Injectable drugs</u>''' <br>
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |  
▸ '''[[Capreomycin]] 15-30 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Kanamycin]] 15-30 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Amikacin]] 15-22.5 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Streptomycin]] 12-18 mg/kg'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 3: Fluoroquinolones</u>''' <br>
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |  
▸ '''[[Levofloxacin]] 7.5-10 mg/kg'''<br> OR <br> ▸ '''[[Moxifloxacin]] 7.5-10 mg/kg'''<br> OR <br> ▸ '''[[Ofloxacin]] 15-20 mg/kg divided q12h (Max:800 mg)'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small>Table adapted </small>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | '''<u>Group 4:Oral bacteriostatic second-line drugs</u>''' <br>
▸ '''[[Ethionamide]] 15-20 mg/kg divided q12h (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Protionamide]] 15-20 mg/kg divided q12h (Max: 1000 mg)''' <br> OR <br> ▸ '''[[Cycloserine]] 10-20 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Terizidone]] 10-20 mg/kg (Max: 1000 mg)'''<br> OR <br> ▸ '''[[Aminosalicylic acid|Para-aminosalicylic acid]] 150 mg/kg divided q8-12h(Max: 12 000 mg)'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small>Table adapted from WHO 2013 Treatment of tuberculosis: guidelines – 4th ed.<ref name="WHO 2013"> {{cite web|  url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref> and Guidance for national tuberculosis programmes on the management of tuberculosis in children <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref></small>
|}
|}
|}
|}
|}




Revision as of 14:11, 1 October 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The primary goal of antiretroviral therapy (ART) is to reduce HIV-associated morbidity and mortality. This goal is best accomplished by using effective ART to maximally inhibit HIV replication, as defined by achieving and maintaining plasma HIV RNA (viral load) below levels detectable by commercially available assays. Durable viral suppression improves immune function and quality of life, lowers the risk of both AIDS-defining and non-AIDS-defining complications, and prolongs life. Based on emerging evidence, additional benefits of ART include a reduction in HIV-associated inflammation and possibly its associated complications.

Medical Therapy

Anti-HIV Medication

Anti-HIV medications (also called antiretrovirals) are grouped into six drug classes according to their mechanism of action. The six classes are as follows:

  1. Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
  2. Nucleoside reverse transcriptase inhibitors (NRTIs).
  3. Protease inhibitors (PIs).
  4. Fusion inhibitors.
  5. CCR5 antagonists.
  6. Integrase inhibitors.

Multidrug regimen has proved to be very beneficial because of reduction in progression to AIDS, opportunistic infections, rate of hospitalizations and deaths. [1]

Goals of Therapy

DHHS ART Guidelines present the following goals for therapy:

  • Durable suppression of HIV viral load ( to <50 cells/mL ).
  • Restoration of normal CD4 cell count.
  • Prevention of transmission of the disease.
  • Prevention of building of drug resistance.
  • Improvement in quality of life of the patient.

Uncontrolled viremia causes inflammation and immune activation, which has an overall effect on cardiovascular, renal and hepatic systems. Controlling viremia also controls these effects.

Indications

Anti Retroviral Therapy (ART)

▸ Click on the following categories to expand treatment regimens.

Anti-retroviral Regimens

  ▸  NNRTI-Based Regimen

  ▸  PI-Based Regimen

NNRTI-Based Regimen
Standard Regimen
PLUS
PLUS
Table adapted
PI-Based Regimen
Standard Regimen
PLUS
PLUS
Table adapted




Related Chapters

References

  1. ↑ Sterne JA, Hernán MA, Ledergerber B, Tilling K, Weber R, Sendi P, Rickenbach M, Robins JM, Egger M (2005). "Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study". Lancet. 366 (9483): 378–84. doi:10.1016/S0140-6736(05)67022-5. PMID 16054937. Retrieved 2012-02-15.
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