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- Gisslén, Magnus, 1962, et al.
(author)
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[Swedish guidelines for antiretroviral treatment of HIV. Good compliance is crucial for a good result]
- 2002
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In: Läkartidningen. ; 99:43, s. 4263-6
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Research review (peer-reviewed)abstract
- Antiretroviral combination therapy has markedly decreased the mortality and morbidity in HIV-disease during the last years. An increasing number of new antiretroviral agents has been introduced and there has been a rapid evolution of new information regarding treatment of HIV. Physicians and patients have to deal with medical associated side-effects, problems with adherence, and viral resistance. Recently a national expert group has prepared guidelines for antiretroviral treatment in HIV-infected adults and adolescents which are summarized in this report. The Swedish guidelines recommend initiation of treatment when the CD4-cell-count is in the range between 200 and 350 x 10(6)/l in asymptomatic HIV-infection. They emphasize that the patient should be carefully prepared before treatment initiation to avoid adherence difficulties which regularly leads to viral failure. As first line is suggested a therapy with 2 NRTIs (nucleoside reverse transcriptase inhibitors) in combination with either a NNRTI (non-nucleoside RTI) or a protease inhibitor. When protease inhibitors are chosen, ritonavir-boosted combinations are most often to prefer. The virological treatment goal is to achieve a decrease in HIV-RNA with 1.5-2 log after 4 weeks and to below 50 copies/ml after 3-4 months of therapy. If a therapy fails, the causes should be carefully investigated for adherence difficulties, medicine interactions, and viral resistance. Treatment change should be guided by a thorough drug treatment history and the results of resistance testing. Treatment of HIV is complex and it is recommended that it should be conducted by an expert in the field.
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