Criteria for Changing Therapy Less than a 0.5–0.75 log reduction in plasma HIV RNA by 4 weeks following initiation of therapy, or less than a 1 log reduction by 8 weeks; Failure to suppress plasma HIV RNA to undetectable levels within 4–6 months of initiating therapy. Repeated detection of virus in plasma after initial suppression [...]
Table 7. Characteristics of nucleoside reverse transcriptase inhibitors (NRTIs) Initiating Therapy in Advanced HIV Disease All patients diagnosed with advanced HIV disease, which is defined as any AIDS-defining condition should be treated with antiretroviral agents regardless of plasma viral levels. All patients with symptomatic HIV infection without AIDS, defined as the presence of thrush or [...]
Initiating Therapy in the Patient with Asymptomatic HIV Infection Tables V and VI summarize the recommendations regarding when to initiate therapy and what regimens to use. In general, any patient with less than 500 CD4 + T cells/mm3 or greater than 10,000 (bDNA) or 20,000 (RT-PCR) copies of HIV RNA/ml of plasma should be offered [...]
Antiretroviral treatment should be offered to all patients with the acute HIV syndrome, those within six months of seroconversion, and all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy in asymptomatic patients depend on virologic and immunologic factors. In general, treatment should be offered to individuals with fewer than 300 CD4 [...]
Involvement of the nervous system in HIV infection is common, manifesting in about half of patients. Neurologic complications Aseptic meningitis. At the time of HIV seroconversion or primary infection, patients may present with symptoms of aseptic meningitis, such as fever, headache, stiff neck, and a lymphocytic pleocytosis. AIDS dementia complex AIDS dementia complex is reported [...]
Estimates of Prevalence and Incidence The best current estimates are that between 600,000 and 800,000 Americans are infected with HIV. For a number of years, Public Health Service (PHS) estimates of the number infected ranged between 1 and 1.5 million, about twice as many as the current estimates. Rosenberg used back calculation to estimate 630,000 to 897,000 [...]
Delirium Delirium is the clinical manifestation of a CNS metabolic disturbance. Systemic illness, CNS infection or neoplasm, and medications may cause delirium in advanced HIV disease. Hypoxia, dehydration, sepsis, renal failure, hyponatremia, hypercalcemia, and hypoglycemia can cause delirium. Delirium may be caused by HIV encephalopathy, cryptococcal meningitis, neurosyphilis, progressive multifocal leukoencephalopathy, herpes encephalitis, cytomegalovirus encephalitis, [...]
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