Guidelines for initiating therapy in treatment naive HIV-infected patients are summarized in Table 50-1. These regulations are based on a consensus assessment of the results of published clinical trials regarding when to initiate treatment, when to change treatment regimens, and which regimens perform best in terms of antiviral efficacy, safety, and tolerability. Practitioners need to be aware that guidelines provide general guidance rather than absolute recommendations for the average uncomplicated patient and may need to be modified based on intercurrent disease, concurrent medications, and other circumstances.
Current treatment guidelines center around two important questions: when to start therapy in treatment-naive individuals and when to change therapy in individuals who are failing their current regimen. The specific drugs recommended may change as new choices become available. However, it is likely that future treatment guidelines will continue to be driven by the important principles mentioned earlier; (1) combination therapy in order to prevent the emergence of resistant virus; (2) emphasis on regimen convenience, tolerability, and adherence in order to chronically suppress HIV replication; and (3) the need for life-long treatment under most circumstances.
For a complete Bibliographical listing see Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th ed., or Goodman & Gilman Online at www.accessmedicine.com.
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