Revista Panamericana de Salud Pública
Print version ISSN 1020-4989
Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. Rev Panam Salud Publica [online]. 2001, vol.10, n.3, pp. 202-216. ISSN 1020-4989. http://dx.doi.org/10.1590/S1020-49892001000900016.
This document presents the most recent update of recommendations from the Department of Health and Human Services of the United States of America concerning the antiretroviral treatment of adolescents and adults who are infected with human immunodeficiency virus (HIV). Among the subjects covered in the document are assessment tests for the viral load, the CD4+ T cell count, and resistance to antiretrovirals; when to begin treatment and with which drugs; when to change treatment and the therapeutic options in that situation; aspects of treating adolescents and pregnant women; treatment adherence; and the drugs' principal side effects. Treatment is indicated for all patients with acute HIV infection, in those who have seroconverted in the preceding 6 months, and in symptomatic patients. With asymptomatic patients, the need for treatment depends on several real or potential risks and benefits. Treatment is usually indicated for asymptomatic individuals with CD4+ T cell counts of < 350/mm3 or with plasma HIV RNA > 55 000 copies/mL with the reverse transcriptase polymerase chain reaction test. Once treatment has begun, goals should include a maximum and durable suppression of the viral load, restoring or maintaining immune function, improving the quality of life, and reducing HIV-related morbidity and mortality. Treatment results are assessed mainly in terms of the plasma HIV RNA level, which should be undetectable (< 50 copies/mL) after 4 to 6 months of treatment. Treatment failure after that period of time can be due to poor treatment adherence, drugs being incompletely suppressive, viral resistance, or other poorly known factors. Treatment should be changed if it fails despite good adherence. This change should be based on a complete analysis of the patient's therapeutic history and on the results of resistance tests.