Tags: Lopinavir

Treatment of HIV / AIDS

Goals of treatment The goal of antiretroviral therapy is to achieve the maximum suppression of HIV replication (HIV RNA level that is less than the lower limit of quantitation). Secondary goals include an increase in CD4 lymphocytes and an improved quality of life. The ultimate goal is decreased morbidity and mortality. General approach to treatment of HIV infection Regular, periodic measurement of plasma HIV RNA levels and CD4 cell counts is necessary to determine the risk of disease progression in an HIV-infected individual and to determine when to initiate or modify antiretroviral treatment regimens. Treatment decisions should be individualized by level of risk indicated by plasma HIV RNA levels and CD4 […]

Antimicrobial Regimen Selection

Introduction A generally accepted systematic approach to the selection and evaluation of an antimicrobial regimen is shown in Table Systematic Approach for Selection of Antimicrobials. An «empiric» antimicrobial regimen is begun before the offending organism is identified, while a «definitive» regimen is instituted when the causative organism is known. Confirming the presence of infection Fever Fever is defined as a controlled elevation of body temperature above the normal range of 36.7 to 37.0В°C. Fever is a manifestation of many disease states other than infection. Many drugs have been identified as causes of fever. Drug-induced fever is defined as persistent fever in the absence of infection or other underlying condition. The fever […]

Antiretroviral Agents General Statement

Abacavir Sulfate, Amprenavir, Atazanavir Sulfate, Delavirdine Mesylate, Didanosine, Efavirenz, Emtricitabine, Enfuvirtide, Indinavir Sulfate, Lamivudine, Lopinavir and Ritonavir, Nelfinavir Mesylate, Nevirapine, Ritonavir, Saquinavir, Stavudine, Tenofovir Disoproxil Fumarate, Zalcitabine, Zidovudine Laboratory Monitoring Plasma HIV-1 RNA Levels and CD4+ T-cell Counts Decisions regarding when to initiate or modify antiretroviral therapy should be guided by monitoring plasma HIV-1 RNA levels (viral load), CD4+ T-cell counts, and the clinical condition of the patient. Although various other surrogate markers and laboratory parameters were used in the past to assess the risk of progression of HIV infection and evaluate efficacy of antiretroviral agents (e.g., peripheral blood mononuclear cell [PBMC] HIV-1 titers, plasma concentrations or levels of HIV p […]

Patient Compliance and Issues Related to Dosage and Administration

Patient Compliance Patient compliance with recommended regimens (even when asymptomatic) is essential to the potential benefits of antiretroviral therapy. Adherence to antiretroviral regimens is an important determinant of both the degree and duration of virologic suppression. Excellent adherence has been shown to increase the likelihood of sustained virologic control, which is important for reducing HIV-associated morbidity and mortality. Poor adherence has been shown to increase the likelihood of virologic failure and can lead to the development of resistance and limit the effectiveness of antiretroviral therapy. There is evidence that nonadherence in patients receiving HAART is the strongest predictor of failure to achieve suppression of viral load to levels below the limits […]

Drug Interactions

Drug Interactions Among the Antiretroviral Agents While further study is needed, data are accumulating regarding pharmacokinetic interactions among the various antiretroviral agents, especially those involving the HIV protease inhibitors and NNRTIs, and the need for dosage adjustments as a result of these interactions. While some pharmacokinetic interactions between antiretroviral agents can be used for therapeutic advantage (e.g., use of low-dose ritonavir to boost plasma concentrations of some other HIV protease inhibitors), other interactions can result in suboptimal drug concentrations and reduced therapeutic effects and should be avoided. The pharmacokinetic interaction between ritonavir and other HIV protease inhibitors is now used for therapeutic advantage in various antiretroviral regimens. Low-dose ritonavir (100-400 mg […]

HIV Protease Inhibitors

The fact that hyperglycemia, new-onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, and diabetic ketoacidosis have occurred in HIV-infected individuals receiving HIV protease inhibitors should be considered when these drugs are used during pregnancy. Because pregnancy is itself a risk factor for hyperglycemia and it is not known whether use of an HIV protease inhibitor exacerbates this risk, glucose concentrations should be monitored closely in pregnant women receiving these drugs and these women should be advised about the warning signs of hyperglycemia and diabetes (e.g., increased thirst and hunger, unexplained weight loss, increased urination, fatigue, dry or itchy skin). Because hyperbilirubinemia (generally reported as an increase in indirect bilirubin) has been […]

Antiretroviral Therapy during Pregnancy

Recommendations for use of antiretroviral agents for the treatment of HIV infection in pregnant HIV-infected women generally are the same as those for nonpregnant HIV-infected adults, and women should receive optimal antiretroviral therapy regardless of pregnancy status. Although zidovudine is the only antiretroviral agent currently labeled for use in pregnant women, most clinicians do not consider pregnancy a contraindication for multiple-drug antiretroviral therapy when such therapy is indicated, especially during the second or third trimester. Therefore, multiple-drug antiretroviral therapy should be discussed with and offered to all HIV-infected pregnant women for their own health. In addition, because there is evidence that use of a regimen that includes both antepartum and intrapartum […]

Antiretroviral Therapy in Pediatric Patients

The same general principles of antiretroviral therapy that apply to HIV-infected adults also apply to HIV-infected pediatric patients; however, the treatment of HIV-infected neonates, children, and adolescents involves unique pharmacologic, virologic, and immunologic considerations. In 1993, the Working Group on Antiretroviral Therapy and Medical Management of HIV-infected Children, a panel convened by the National Pediatric and Family HIV Resource Center (NPHRC), the Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH) first issued guidelines for the use of antiretroviral agents in the treatment of HIV-infected children. At that time, monotherapy with zidovudine or didanosine was considered an appropriate regimen for initial therapy in HIV-infected pediatric patients. However, […]

Antiretroviral Therapy in Previously Treated Adults

Antiretroviral regimens should be modified in individuals receiving a regimen considered to be suboptimal (e.g., monotherapy or a 2-drug regimen that includes only NRTIs); individuals who are experiencing toxicity or intolerance on their current regimen; individuals who have who had an initial response to a potent regimen and undetectable plasma HIV-1 RNA levels but are now experiencing disease progression or have detectable levels of plasma HIV-1 RNA; and individuals who have been receiving a potent regimen and whose viral load was never suppressed below the limits of detection. Optimal antiretroviral therapy involves continuous evaluation of the patient's response to the current regimen since the duration of clinical benefit from any one […]

Asymptomatic HIV Infection

The optimal time to initiate antiretroviral therapy in asymptomatic patients is unclear. A decision to initiate antiretroviral therapy in an HIV-infected adult or adolescent who is asymptomatic should be made after considering the patient's willingness to begin antiretroviral therapy; the prognosis for disease-free survival in the absence of treatment as determined by baseline CD4+ T-cell count, plasma HIV-1 RNA level, and the rate of decline in CD4+ T-cell counts; and the potential benefits and risks of antiretroviral therapy. Because observational data and data from clinical studies indicate that the risk of opportunistic diseases increases markedly when CD4+ T-cell counts decrease to less than 200/mm3, most clinicians recommended that antiretroviral therapy be […]