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Initial therapy for HIV





Guidelines for using antiviral therapy have been developed and are updated on a regular basis by an expert panel assembled by the DHHS and the Henry J. Kaiser Foundation and the IAS-USA Panels. The DHHS guidelines are only one of several developed to provide recommendations for the treatment of HIV disease (www.hivatis.org). The most recent IAS-USA Guidelines were published in the Journal of the American Medical Association (JAMA) in the summer of 2004.

Antiviral treatment options have primarily included combinations of 2 nucleoside analogue reverse transcriptase inhibitors (NRTI), often referred to as "nucs," and 1 PI. In addition, together with 2 NRTIs, several combinations of 2 PIs have been used instead of a single PI because these regimens are easier to follow and/or have fewer side effects. Alternative preferred regimens include NRTIs with NNRTIs, often called "non-nucs." These NNRTI-containing combinations generally are easier to take than PI-containing combinations and tend to have different side-effects. Although there has been a great deal of interest in the possibility of using an all NRTI regimen, usually as 3 drugs from this class in combination, studies show that, at best, they are less potent than other treatment options. In addition, there are some triple NRTI combinations that have been shown not to be effective and that should be avoided, such as the nucleotide analogue RTI tenofovir (VireadTM, TDF) with 3TC and abacavir (ZiagenTM, ABC) and TDF, didanosine (VidexTM, ddI) and ABC. Results using combinations of 4 NRTIs are limited at this time.