This document provides information about Highly Active Antiretroviral Therapy (HAART) for treating HIV. It discusses the history and development of HAART, which involves using multiple antiretroviral drugs together to suppress the virus. Early combinations included two nucleoside reverse transcriptase inhibitors with a protease inhibitor. The goals of ART are to prolong life, improve quality of life, and reduce viral load and transmission risk while maintaining treatment options. Guidelines recommend starting ART for all individuals to reduce disease progression.
MANAGEMENT OF HIV FALLS UNDER THREE MAJOR CATEGORIES
1.POST EXPOSURE PROPHYLAXIS(P.E.P)
2.TREATMENT/MANAGEMENT OF HIV-AIDS
3.TREATMENT OF ADJOINING CONDITIONS
eg-
-Fungal Infections
-Bacterial infections
-Viral infections
-NEOPLASIAS
-misc.( recurrent apthos ulcers, xerostomia,salivary G. enlargement)
Lizzy Schmidt, Director of the Woman's Program at Philadelphia FIGHT's Jonathan Lax Center, presented on HIV Treatment and PrEP at the June 2015 Ryan White Part A Planning Council meeting.
MANAGEMENT OF HIV FALLS UNDER THREE MAJOR CATEGORIES
1.POST EXPOSURE PROPHYLAXIS(P.E.P)
2.TREATMENT/MANAGEMENT OF HIV-AIDS
3.TREATMENT OF ADJOINING CONDITIONS
eg-
-Fungal Infections
-Bacterial infections
-Viral infections
-NEOPLASIAS
-misc.( recurrent apthos ulcers, xerostomia,salivary G. enlargement)
Lizzy Schmidt, Director of the Woman's Program at Philadelphia FIGHT's Jonathan Lax Center, presented on HIV Treatment and PrEP at the June 2015 Ryan White Part A Planning Council meeting.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
haart-170422040325.pdf
1. D R A B H I S H E K K G U P T A
Highly Active Antiretroviral
Therapy (HAART)
2. Introduction
The use of multiple drugs that act on different viral
targets is known as highly active antiretroviral
therapy (HAART)
HAART decreases the patient's total burden of HIV,
maintains function of the immune system, and
prevents opportunistic infections that often lead to
death
3. History
The first effective therapy against HIV was the nucleoside
reverse transcriptase inhibitor (NRTI) zidovudine (AZT)
To distinguish from this early anti-retroviral therapy (ART),
the term highly active anti-retroviral therapy (HAART) was
introduced
Hammer and colleagues and Gulick and co-
investigators illustrating the substantial benefit of
combining 2 NRTIs with a new class of anti-
retrovirals, protease inhibitors, namely indinavir. This
concept of 3-drug therapy was quickly incorporated into
clinical practice and rapidly showed impressive benefit with
a 60% to 80% decline in rates of AIDS, death, and
hospitalization.
4. Goals of Antiretroviral Therapy
The currently available ARV drugs cannot eradicate
the HIV infection from the human body
Clinical goals : Prolongation of life and improvement
in quality of life
Virological goals : Greatest possible reduction in
viral load for as long as possible
Immunological goals : Immune reconstitution that is
both quantitative and qualitative
Reduction of HIV transmission in individuals :
Reduction of HIV transmission by suppression of
viral load
5. Therapeutic goals : Rational sequencing of drugs in a
fashion that achieves clinical, virological and
immunological goals while maintaining treatment
options, limiting drug toxicity and facilitating
adherence
9. Current guidelines: when to start ART
Current US DHHS guidelines (published April 8,
2015) state:
Antiretroviral therapy (ART) is recommended for all
HIV-infected individuals to reduce the risk of disease
progression.
AIDS-defining condition
Pregnancy
Symptomatic from HIV including any of the
following:
1. HIV-associated neurocognitive disorder (HAND)
10. 2. Severe thrombocytopenia
3. HIV-associated nephropathy
4. HIV-related malignancies
5. Chronic hepatitis B or C infection and,
6. Age 50 or older
Patients with seronegative partners should be
counselled
Decisions to initiate ART should be individualized,
particularly for long-term nonprogressors or and for
patients with potential barriers to adherence
11. Current World Health Organization guidelines
(dated June 30, 2013)
Initiate ART if CD4 cell count ≤500 cells/ml
• As a priority, initiate ART in all individuals with
severe/advanced HIV disease (WHO clinical stage 3 or 4)
or CD4 count ≤ 350 cells/mm
Initiate ART regardless of WHO clinical stage or CD4 cell
count in
• Active TB disease
• HBV co-infection with severe chronic liver disease
• Pregnant and breastfeeding women with HIV
• HIV-positive individual in a serodiscordant partnership
(to reduce HIV transmission risk)
12. When to start ART in Adults and Adolescents
WHO Clinical Stage WHO Clinical Stage
HIV infected Adults & Adolescents (Including pregnant women)
Clinical Stage I and II Start ART if CD4 < 350 cells/mm3
Clinical Stage III and IV Start ART irrespective of CD4 count
For HIV and TB co-infected patients
Patients with HIV and TB co-infection
(Pulmonary/ Extra-Pulmonary)
Start ART irrespective of CD4 count
and type of tuberculosis (Start ATT
first, initiate ART as early as possible
between 2 weeks to 2 months when TB
treatment is tolerated)
For HIV and Hepatitis B and C co-infected patients
-Without any evidence of chronic
active Hepatitis
Start ART if CD4 < 350 cells/mm3
-With documented evidence of chronic
active Hepatitis
Start ART irrespective of CD4 count
13. Counseling and Education Before
Initiating ART
RECOMMENDATIONS: Counselling and education
should include the following:
Basic education about HIV, CD4 cells, viral load, and
resistance
Available treatment options and potential risks and
benefits of therapy
The need for strict adherence to avoid the
development of viral drug resistance
Use of safer-sex practices and avoidance of needle-
sharing activity, regardless of viral load, to prevent
HIV transmission or super-infection
14. BENEFITS AND RISKS OF EARLY ART IN
ASYMPTOMATIC HIV-INFECTED PATIENTS
Early therapy = initiation at CD4 counts >500
cells/mm3 )
Benefits of early therapy
Earlier treatment reduces both HIV-related and non-
HIV-related morbidity and mortality
Delay or prevention of immune system compromise
Possible lower risk of antiretroviral resistance
Decreased risk of sexual transmission of HIV
15. Disadvantages of early therapy
Potential drug-related reduction in quality of life in
otherwise asymptomatic individuals
Possibility of greater cumulative side effects from
ART
Possibility for earlier development of drug resistance
and limitation in future antiretroviral options if
adherence and viral suppression are suboptimal
Possibility for earlier onset of treatment fatigue
Higher prescription drug costs for the individual
16. Potential barriers to adherence include:
Communication difficulties that arise when the
patient’s attitude about disease and therapy is
different from that of the provider’s. Without open
and nonjudgmental communication from the
healthcare team, patients may not trust or may
misunderstand the prescribed regimen
Language or literacy barriers
Unstable living situations (including limited or absent
social support)
Discomfort with disclosure of HIV status, which may
become known when medications are taken
17. Inability to set long-term goals
Inadequate knowledge about disease and
effectiveness of medications or healthy living,
including a patient’s lack of belief in his/her ability
to take medications regularly
Difficulty accessing adequate healthcare
Housing, food, lack of childcare, or other immediate
life needs, which are viewed as more pressing than
taking the medications regularly
19. VIROLOGIC AND IMMUNOLOGIC MONITORING FOR NON-PREGNANT PATIENTS
HIV RNA Levels
(copies/mL)
CD4 Lymphocyte Count
(cells/mm3 )
Baseline
All patients Yes Yes
Treatment Monitoring
Following: (1) initiation
of ART or (2) a change in
ART regimen after
virological failure with
new resistance to prior
ART
Within 4 weeks of
initiation of ART or
change in regimen.
At least every 8 weeks
until complete
suppression is
documented
Repeat at 12 weeks and
then every 4 months until
CD4 >200 cells/mm3 on
two measurements
obtained at least 4 months
apart, then monitor as
below once suppressed
Following a change in
ART to simplify
treatment regimen or
reduce toxicity for
patients with suppressed
virus
Within 4 weeks after
change in regimen
Monitor as below for
suppressed
20. Patients on ART who
achieve complete
suppression
At least every 4 months
after complete
suppression .
May extend intervals to
every 6 months in
selected stable patients
with CD4 counts >200
cells/mm3 after 1 year
of complete suppression
If CD4 300 to 500
cells/mm3 :At least
every 6 months .
If CD4 >300 to 500
cell/mm3:At least every
12 months.
If CD4 >500 cells/mm3
:further monitoring is
optional
Patients Not on ART:
all HIV-infected
patients should be
offered ART regardless
of CD4 count
If CD4 ≤500 cells/mm3:
At least every 4 months
If CD4 >500 cells/mm3:
At least every 6 months
If CD4 ≤500
cells/mm3: At least
every 4 month.
If CD4 >500 cells/mm3:
At least every 6 month
21. HIV Resistance Assays
Clinicians should perform resistance testing under
the following circumstances:
At baseline, regardless of whether ART is being
initiated (genotypic testing)
In patients experiencing treatment failure or
incomplete viral suppression while receiving ART
(genotypic and/or phenotypic testing)
Genotypic assays detect mutations in the genes of the
reverse transcriptase and protease enzymes, as well
as the gp41 domain for the currently available fusion
inhibitors
22. Phenotypic assays directly measure susceptibility of
the patient’s HIV strain to specific individual drugs
compared to sensitive HIV
23. Classes of drugs
There are five classes of drugs, which are usually used
in combination, to treat HIV infection
1. Nucleoside reverse transcriptase inhibitors
(NRTI) and nucleotide reverse transcriptase
inhibitors (NtRTI)- are nucleoside and nucleotide
analogues which inhibit reverse transcription. HIV is
an RNA virus and hence unable to become integrated
into the DNA in the nucleus of the human cell; it
must be "reverse" transcribed into DNA. Since the
conversion of RNA to DNA is not done in the
mammalian cell it is performed by a viral protein
which makes it a selective target for inhibition.
24. NRTIs are chain terminators such that once
incorporated, work by preventing other nucleosides
from also being incorporated into the DNA chain
because of the absence of a 3’ OH group. Both act
as competitive substrate inhibitors. Examples of
currently used NRTIs includes Zidovudin, Abacavir,
Lamivudine, Emtricitabine and tenofavir.
2. Non-Nucleoside reverse transcriptase
inhibitors (NNRTI)- Inhibit reverse
transcriptase by binding to an allosteric site of the
enzyme; NNRTIs act as non-competitive
inhibitors of reverse transcriptase
25. NNRTIs can be further classified into 1st generation and
2nd generation NNRTIs.
1st generation NNRTIs include Nevirapine and
Efavirenz.
2nd generation NNRTIs are Etravirine and Rilpivirine.
HIV-2 is naturally resistant to NNRTIs.
3. Protease inhibitors- block the viral protease enzyme
necessary to produce mature virions upon budding
from the host membrane. Particularly, these drugs
prevent the cleavage of gag and gag/pol precursor
proteins
26. Examples of HIV protease inhibitors are Lopinavir,
Indianavir, Nelfinavir, Amprenavir and Ritonavir.
Darunavir and Atazanavir are currently recommended
as first line therapy choices.
Resistance to some protease inhibitors is high.
4. Integrase inhibitors (also known as integrase
nuclear strand transfer inhibitors or INSTIs)-
Raltegravir became the first to receive FDA
approval in October 2007. As of early 2014, two
other clinically approved integrase inhibitors
are elvitegravir and dolutegravir.
27. Entry inhibitors- (or fusion inhibitors) interfere
with binding, fusion and entry of HIV-1 to the host
cell. Maraviroc and enfuvirtide are the two currently
available agents in this class.
Maraviroc works by targeting CCR5, a co-receptor
located on human helper T-cells.
Enfuvirtide is a peptide drug that must be injected
and acts by interacting with the N-terminal heptad
repeat of gp41 of HIV to form an inactive hetero six-
helix bundle, therefore preventing infection of host
cells.
28. Regimens
Most current HAART regimens consist of three drugs:
2 NRTIs ("backbone")+ a PI/NNRTI/INSTI ("base").
Initial regimens use "first-line" drugs with a high efficacy
and low side-effect profile.
The US DHHS preferred initial regimens for adults and
adolescents in the United States, as of April 2015, are:
tenofovir/emtricitabine and raltegravir (an integrase
inhibitor)
tenofovir/emtricitabine and dolutegravir (an integrase
inhibitor)
abacavir/lamivudine (two NRTIs) and dolutegravir for
patients who have been tested negative for the HLA-
B*5701 gene allele
29. tenofovir/emtricitabine, elvitegravir (an integrase
inhibitor) and cobicistat (inhibiting metabolism of
the former) in patients with good kidney function
(gfr > 70)
tenofovir/emtricitabine, ritonavir,
and darunavir (both latter are protease inhibitors)
The WHO preferred initial regimen for adults and
adolescents as of June 30, 2013 is:
tenofovir + lamivudine (or emtricitabine) + efavirenz
30. For Children
The WHO & DHHS recommends for children less
than 3 years:
abacavir (or zidovudine) + lamivudine + lopinivir/
ritonivir
For children 3 years to less than 10 years and
adolescents <35 kilograms:
abacavir + lamivudine + efavirenz
43. Do not start ART in the presence of an active OI. In
general, OIs should be treated or stabilized before
commencing ART. Mycobacterium avium complex
(MAC) and progressive multifocal
leukoencephalopathy (PML) are exceptions, in
which commencing ART may be the preferred
treatment.
Manage OIs before Starting
ART
48. HIV and Hepatitis Co-infection
HIV modified the natural history of HBV infection,
higher rate of progression to advance liver disease
among co infection.
Choice of ART- ARV with anti HBV activity such as
3TC and TDF
First line regime- TDF + 3TC +EFV
Alternative – AZT+ 3TC+EEV
No ARV drugs are active against HCV infection , but
they decline the progression
51. Second line regime
A second-line regimen should be recommended only
by CoE/ ART plus Centre.
When failure has been identified clinically or
immunologically, many patients can be expected to
have significant NRTI resistance at the time of
switching
Cross resistance exists between d4T and AZT; thus
NRTI-component in the second-line regimens should
be either ddI/ABC or TDF/ABC.
High level AZT/3TC resistance reduces susceptibility
to ABC.
52. NNRTI (such as EFV and NVP): usually there is
complete cross-resistance
56. Final words
HIV care requires, as always, partnerships and open
communication. The provider can make
recommendations most likely to lead to positive
outcomes only if the patient's own point of view and
social context are well known.
Guidelines are only a starting point for medical
decision making. They can identify some of the
boundaries of high-quality care but cannot substitute
for sound judgment.