Current recommendations
are to consider antiretroviral therapy for all infected individuals, but
certainly under the following circumstances:
-
CD4+ T-Cell counts < 500,
or
-
CD4+ T-Cells > 500, but plasma
viral load exceeds 30,000 to 50,000 HIV RNA copies/ml
-
Co-infection with hepatitis C.
-
Concurrent HIV associated renal disease.
Two drug regimens fail and resistance
quickly develops.Multi-drug antiretroviral
therapy provides most profound and long lasting suppression of viral replication.
The regimen should contain:
-
Two reverse transcriptase inhibitors,
plus a non nucluoside inhibitor
-
Two reverse transcriptase inhibitors, plus
A 'boosted' protease inhibitor
- Two reverse transcriptase inhibitors,
plus an integrase inhibitor
- Several combination pills now
available:
- Atripla, Complera and Stribild
- Taken once a day, thus helping with compliance.
Such multi-drug therapies
should maintain plasma viral loads below currently detectable limits (<
20 RNA copies/ml) for up to 2 years in 80% of patients.
Early and effective treatment also lowers
transmission rate.
Drug failure rate is about 1% per year, mostly due to non-compliance. |