4.1. AIDS General Treatment Information: Summary
Description
This article is from the AIDS FAQ, by Dan Greening with numerous contributions by others.
4.1. AIDS General Treatment Information: Summary
Given this complex and seemingly confusing information, what
recommendations can be given to the clinician? Most important is to
individualize the decision-making and to consider the desires of the
patient even more than previously. Some patients gravitate easily to
more aggressive therapy, while others prefer a more conservative
therapeutic approach. With the former, initiating therapy at or even
above 500 CD4 counts, perhaps even with a combination of zidovudine
and ddI, may be considered. For more conservative patients, however,
following the recommendations of the Concorde study may in order. In
other words, defer the initiation of zidovudine monotherapy until the
onset of clinical symptoms. Once the choice of initial therapy has
been made, all other recommendations must also be individualized. No
firm data are available to guide the decision about how long to
continue a therapy or even about what to use next. Most of these
options have not been compared directly in clinical trials. It would
seem advisable to continue therapy longer in patients with relatively
earlier disease when therapy is initiated. On the other hand, if
patients have more advanced disease, for example, are symptomatic or
have CD4 cell counts below 300 when therapy is begun, then a more
rapid alteration of therapy to a non-cross-resistant drug or
combination should be considered. The goal in each patient is to
continue effective antiretroviral therapy for as long as possible,
discontinuing the therapy if further benefits appear
impossible. Although the results of recent clinical trials are
disappointing in some respects, it nevertheless is important to have
these data. Only then can we adjust our expectations and our patients'
expectations of antiretroviral treatment and learn how to make the
best use of the drugs that we have available. Recognizing the
increasing need for the development of new classes of more effective
drugs in combinations, we must still seek to maintain the optimism
that enables progress in our patients' care.
Dr. Volberding is a UC San Francisco professor of medicine and
Director, UCSF AIDS Program at San Francisco General Hospital.
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