Recovery of immune function after ART is started is variable but generally not related to the ART regimen used. Duration of the HIV infection and degree of immunodeficiency when ART is commenced (nadir CD4+ T cell count) are much more important factors. Age is another very important factor, with a slower and often blunted immune …
Immunological failure: persistent CD4+ T cell deficiency Read More »
Antiretroviral drug toxicity and DDIs are both reasons for revising an antiretroviral drug regimen but thankfully are encountered much less frequently than they were in the first two decades of ART. Detailed consideration of renal, bone, endocrine, cardiovascular disease and drug hypersensitivity reactions are covered in specific subsections of the “Co-morbidities” and “ARV drugs and …
Principles of managing antiretroviral drug toxicity and drug-drug interactions Read More »
Patient adherence to medication is the cornerstone of successful long-term treatment. Simpler dosing regimens are associated with improved adherence and virological control. Other reasons to consider regimen simplification may arise in both treatment-naïve and treatment-experienced patients, most commonly due to the presence of comorbidities, and avoidance or management of long-term toxicity and adverse effects. Decisions …
BHIVA guidelines for the routine investigation and monitoring of adult HIV-1-positive individuals 2016 (2019 interim update). Available at: https://www.bhiva.org/monitoring-guidelines Laboratory Testing for Initial Assessment and Monitoring of Patients with HIV Receiving Antiretroviral Therapy. US Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Available at: https://aidsinfo.nih.gov/guidelines/html/1/adult-and- adolescent-arv/3/tests-for-initial-assessment-and-follow-up European AIDS Clinical …
After the initial diagnosis of HIV infection and establishment of a care plan, ongoing regular engagement with HIV treatment services is known as “retention in care” and has been defined as having at least two monitoring visits with an HIV medical provider spaced at least three months apart within 1 year. Retention in care has …
Mark Bloch1, Craig Rodgers2 Holdsworth House Medical Practice and East Sydney Doctors, Sydney NSW St Vincent’s Hospital, Sydney NSW Last reviewed: March 2016 Next review due: December 2019 Initiation of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) in the naïve patient centres around two main questions: When to start therapy and what to therapy …
Initiation of antiretroviral therapy in the treatment-naïve patient Read More »
In the Australian context, ASHM Sub-Committee for Guidance on HIV Management recommends that antiretroviral therapy should be initiated in all people with HIV, irrespective of CD4 count, taking into account the following principles:[15] ART is recommended for all individuals with HIV infection, irrespective of CD4 count, to reduce the risk of disease progression. The decision …
When to start therapy in the individual with HIV Read More »
When selecting a regimen for an individual patient, a number of patient- and regimen-specific characteristics should be considered, with the goal of providing a potent, safe, tolerable and easy to adhere to regimen for the patient in order to achieve sustained virological control. Some of the factors can be grouped into the following categories: Initial …
Which regimen to use in the individual with HIV infection Read More »
Acute or primary HIV infection Improved recognition of the clinical syndrome suggestive of acute HIV or primary HIV infection combined with use of newer diagnostic tests enables early identification of this group of individuals and thus consideration of antiretroviral therapy. The SPARTAC study randomised patients with primary HIV infection to 48 weeks vs 12 weeks …
HIV and hepatitis C co-infection HIV-hepatitis C virus (HCV) co-infection is increasingly prevalent in Australia, affecting approximately 10% of those with HIV, and with clinical consequences for both diseases. The rate of progression of liver disease from hepatitis C has long been known to be accelerated in the setting of co-infection and a recent meta-analysis …
Antiretroviral treatment in specific clinical scenarios Read More »
Developing a sustainable HIV, Viral Hepatitis and Sexual Health Workforce
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