[Guidelines for implementing antiretroviral therapy].

Abstract

The rapid evolution of new information has introduced extraordinary complexity into the treatment of HIV-infected persons. Therefore it is recommended that care should be supervised by an expert. With regard to specific recommendations, treatment should be offered to all patients with the acute HIV syndrome and all patients with symptoms ascribed to HIV infection. The strength of the recommendation to treat asymptomatic patients should be based on the patient's willingness to accept therapy, the probability of adherence with the prescribed regimen, and the prognosis in term of time to an AIDS-defining disease as predicted by plasma HIV RNA levels and CD4+ T-cell counts. Once the decision has been made to initiate antiretroviral therapy, the goal is maximum viral suppression for as long as possible. Results of therapy are evaluated primarily with plasma HIV RNA levels: these are expected to show a one-log (10-fold) decrease at 8 weeks and no detectable virus at 4 to 6 months after initiation of treatment. Failure of therapy may be ascribed to nonadherence, inadequate potency of drugs or suboptimal levels of antiretroviral agents, resistance, and other factors that are poorly understood. Patient education and involvement in therapeutic decisions is important for all medical conditions but is considered especially critical for HIV-infection and its treatment.