4.1. AIDS General Treatment Information: Review of Clinical Guidelines
Description
This article is from the AIDS FAQ, by Dan Greening with numerous contributions by others.
4.1. AIDS General Treatment Information: Review of Clinical Guidelines
Antiretroviral therapy clearly has shown activity in delaying the
progression and death of patients with HIV infection, especially when
therapy has been tested in patients with more advanced disease. But
even in asymptomatic HIV infection there is a general agreement of at
least a transient clinical benefit from the use of nucleoside analog
therapy. It is clear also that antiretroviral therapy improves various
laboratory markers of the disease, including immunologic and virologic
disease markers, such as CD4 cell counts and HIV p24 antigen
levels. Further evidence of the clinical activity of these drugs comes
from trials showing a second period of benefit when therapy is changed
to a non-cross-resistant agent, for example, switching from zidovudine
to ddI. In addition, we are encouraged by symptomatic improvement in
patients with advanced disease who are started on antiretroviral
drugs. Also, many retrospective epidemiology studies continue to show
a survival advantage in patients taking these drugs. Despite
continuing agreement on some of the benefits of antiretroviral
therapy, we also face growing uncertainties. Recent studies have shown
no survival advantage when antiretroviral drugs are used in
asymptomatic HIV infection, and any benefit in slowing clinical
progression seems to disappear when zidovudine monotherapy, at least,
is given for a prolonged period. Questions continue as well about the
degree of benefit of antiretroviral therapy for patients with advanced
HIV disease. Early clinical trials of zidovudine, for example, were
done before the routine used of PCP prophylaxis, which, by itself,
delays progression to that common indicator of AIDS. Questions about
the current status of antiretroviral therapy include: Which drug or
combination is superior as initial therapy? When should this initial
therapy begin? What is the duration of the benefit from initial
therapy? How long should it be continued before other drugs or
combinations are initiated? Finally it is important to consider: Which
drugs should be used following initial therapy? What might we
anticipate in the future from drugs in current clinical development?
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