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It is therefore estimated that eradication of HIV with ART alone would take at least a decade and so the goal of treatment must now be redirected towards the long-term management of a chronic infection.
The ultimate aim of antiretroviral treatment must be maximal suppression of HIV replication because the major short-term risk of any continuing viral replication in the presence of antiretroviral drugs, is the emergence of drug resistance. Decisions about when to start therapy and what regimens to use are crucial because future treatment options may be severely compromised by an initial regimen that is inadequately adhered to or insufficiently potent.
Physicians and patients together need to weigh the advantages and disadvantages of starting antiretroviral therapy and make individualised informed decisions. Arguments in favour of early initiation of antiretroviral treatment include: According to current published international guidelines, the following broad criteria guide the selection of patients for initiation of therapy: Current guidelines recommend that treatment be considered for patients in the intermediate range, i.
Choice of regimen Several regimens with acceptable antiviral potency are available, particularly for patients being treated for the first time.
These regimens are composed of three to four drugs.
The choice of specific NRTI is based on convenience, adverse effects and patient preference. Similarly, didanosine and zalcitabine may lead to additive neurotoxicity and should not be combined.
Addition of a reduced dose of ritonavir to saquinavir, indinavir or amprenavir improves the pharmacokinetic profiles, may reduce pill burden, lower the dose frequency, lower cost, and obviate the need for administration of PIs on an empty stomach.
The long-term benefit and toxicity of dual PI combinations remains to be fully characterised.
There is convincing evidence from controlled clinical trials that in treatment-naive patients, NNRTI regimens offer a suitable alternative to Pi-containing combinations in terms of antiviral potency. Besides the advantage of deferring the introduction of PIs, NNRTI containing regimens may also allow for a lower pill burden and for improved adherence.
The main disadvantage of NNRTIs is the ease and rapidity with which resistance develops to the individual drugs in this class if they are used in the context of a regimen that is not maximally suppressive and the very strong likelihood that cross class resistance will follow.
This combination, however, seems to have reduced potency in patients with high baseline plasma viral loads. Once again, the long-term efficacy and toxicity of multinucleoside regimens remains unknown and there is concern over the potential possibility of selecting for multinucleoside-resistant variants of HIV.
There is no data at present demonstrating superiority of any one of the above acceptably potent initial regimens over the others and recommendations for a specific initial regimen or for a specific combination of individual drugs cannot be made.
The choice of a particular regimen remains individualised with consideration given to the strength of supportive data, the tolerability of the regimen, the potential for adverse effects, likely drug-drug interactions, convenience and likelihood of adherence and the potential for alternative treatment options should an initial combination fail.Handle information in health and social care settings.
Identify the legislation that relates to the recording, storage and sharing of information in health and social care.
and Explain why it is important to have secure systems for recording and storing information in a health and social care . The importance of the doctor-patient relationship in adherence to HIV/AIDS treatment: A case yunusemremert.com the diagnosis and treatment of disease.1 2 3 In this essay I address the question of who.
New Benefits of Antiretroviral Therapy Uncovered by Jeffrey Laurence, M.D. Early treatment also lowered cellular HIV reservoir size. Dr. which could lead to increased risk of AIDS- and non-AIDS-related health problems.
The social connection theory suggests that in resource poor settings, people access HIV treatment following support from social connectors who encourage them to access the health care service.
This support may be through the provision of information, encouragement and counselling, informal connections, giving ‘notes’ or letters. health care for undocumented immigrants and considers the impacts of the ACA on the health the costs of emergency care and other treatment for undocumented immigrants without insurance usually becomes uncompensated care.
This will disadvantages in health status. MicroSimulation models show undocumented immigrants will. Socio-economic and health characteristics of HIV-infected patients seeking care in relation to access to the Drug Access Initiative and to antiretroviral treatment in .