Highly Active Antiretroviral Therapy (HAART) involves using a combination of at least three antiretroviral drugs to suppress the HIV virus and stop the progression of HIV disease. HAART decreases the viral load, improves immune function, and prevents opportunistic infections. The goals of HAART are to prolong life, improve quality of life, achieve maximal viral suppression, restore immune function, reduce HIV transmission, and rationally sequence drugs to limit toxicity while maintaining treatment options. Current guidelines recommend starting ART for all individuals regardless of CD4 count. Second line regimens are recommended when clinical or immunological failure occurs on first line therapy. Managing adverse events and comorbidities like hepatitis co-infection is also
A decrease in red blood cells when the body can't absorb enough red blood cells.It is an organ specific autoimmune diseases in which the body’s immune system attacks the lining of the stomach.
It was considered as a deadly disease due to the lack of available treatment.
Pernicious anemia is most common in caucasian persons of north European ancestry than in other racial groups.
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
A decrease in red blood cells when the body can't absorb enough red blood cells.It is an organ specific autoimmune diseases in which the body’s immune system attacks the lining of the stomach.
It was considered as a deadly disease due to the lack of available treatment.
Pernicious anemia is most common in caucasian persons of north European ancestry than in other racial groups.
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
Scale up of Prevention of Mother to Child HIV Transmission Programme in Delhi...Anil Gupta
We are still using SD NVP prophylaxis even though there is enough evidence that multi-drug regimens are much better. NACO, MoHFW, Govt of India is implementing new PMTCT strategy in Delhi in 2013-14 which will eliminate Pediatric HIV infections in the coming years.The presentation highlights key features of the New PMTCT Strategy of the country.
AIDS and its vengeance saw a back seat after we achieved the zero level of growth for it. But worries regarding the people living with AIDS are still on and we need to take care of these segments in an integrated manner
HIV AIDS is one of the most dreadful of all diseases. Newer drugs and drug combination are coming quite frequently. Attempts to design an HIV vaccine is also underway.
This seminar is my attempt this interesting topic with all the latest data I could collect on the internet.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
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)
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
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
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.