24 Mar

Antiretroviral Therapy – inhibitors – part3

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 unexplained fever, should also be treated.

Special Considerations in the Patient with Advanced Stage Disease

Some patients present with opportunistic infections, wasting, dementia or malignancy and are first diagnosed with HIV infection at this advanced stage of disease. All patients with advanced HIV disease should be treated with antiretroviral therapy. When the patient is acutely ill with an OI or other complication of HIV infection, the clinician should consider clinical issues such as drug toxicity, ability to adhere to treatment regimens, and laboratory abnormalities when determining the timing of initiation of antiretroviral therapy. Once therapy is initiated, a maximally suppressive regimen, such as 2 NRTIs and a protease inhibitor, should be used, as indicated in Table VI. Advanced stage patients being maintained on an antiretroviral regimen should not have the therapy discontinued during an acute opportunistic infection or malignancy, unless there are concerns regarding drug toxicity, intolerance, or drug interactions.

Class Adverse Events

Several class-related adverse events have been recognized with antiretroviral during the post-marketing period. For nucleoside analogue reverse transcriptase inhibitors (NRTIs), lactic acidosis with hepatomegaly and hepatic steatosis has been reported. For protease inhibitors reports of hyperglycemia/diabetes mellitus, increased bleeding episodes in patients, and fat redistribution with and without serum lipid abnormalities have been received.

Table 8. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Table 9. Characteristics of protease inhibitors (PIs) 

Table. 10 Drugs that should not be used with protease inhibitors

Table 11. Drug interactions between protease inhibitors and other drugs; drug interactions requiring dose modifications

Table 13. Drugs Available Through Treatment Investigational New Drug Protocols 

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