guidelines for the use of antiretroviral agents in hiv infections in taiwan, revised in 2002 by...
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Guidelines for the use of antiretroviral agents in HIV
infections in Taiwan, revised in 2002
by Infectious Diseases Society of the ROC and Taiwan AIDS
Society
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Guidelines for the use of antiretroviral agents in HIV infections
Significant progress in the field of antiretroviral therapy over the past year .
New drugs approved for clinical use and new insights gained in many aspect of therapy.
An update of the first “Guidelines for the use of antiretroviral agents in HIV infections in Taiwan” established in March 11, 2001, and organized a meeting on November 24, 2001.
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Guidelines for the use of antiretroviral agents in HIV infections
The new guidelines: more conservative in the
initiation of treatment in asymptomatic patients, and
offered an option for treatment in patients with
CD4+ T cells >350/mm3
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Guidelines for the use of antiretroviral agents in HIV infections
Other important issues not included in this guidelines:
the side effects, drug resistance, patients compliance,
prevention of opportunistic infections,
Immunotherapy, and vaccine.
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Guidelines for the use of antiretroviral agents in HIV-
infected patients
A. General consideration
1.When to start
(1) Acute HIV infection: treatment should be offered.
(2) Symptomatic: treatment should be offered.
(3) Asymptomatic:
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Adult:Treatment should be offered:
CD4+ T cells <350/mm3, or
HIV RNA >30,000 copies/ml (bDNA), or
HIV RNA >55,000copies/ml (RT-PCR).
Treatment may be deferred:
CD4+ T cells >350/mm3, or
HIV RNA <30,000 copies/ml (bDNA), or
HIV RNA <55,000copies/ml (RT-PCR).
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Pediatrics:Treatment should be offered to all newlydiagnosed infected children, if universal earlytreatment not feasible, treatment should beoffered if there is evidence of immune suppression as followings:
CD4+ T cells
Ages No./mm3 %
1-5 yrs <1000 <25%
6-12 yrs <500 <25%
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2.When to change
(1)Virologic failure: a. A reduction in plasma HIV RNA of less than
0.5 to 0.7 log10 4 weeks following initiation of
therapy; or less than 1 log10 by week 8.
b. Failure to suppress plasma HIV RNA to
undetectable levels within 4 -6 months after
initiation of therapy.
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c. Repeated detection of virus in plasma after initial suppression to undetectable level, suggesting the development of resistance. d. Any reproducible significant increase, defined as 3-fold or greater, from the nadir of plasma HIV RNA not attributable to intercurrent infection, vaccination, or test methodology.(2) Toxicity(3) Intolerance
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B. Recommended regimensa
1.Acute HIV infection
Drug of choice Alternative A B A B Indinavir Combivirb Abacavir AZT+3T
C Saquinavir d4T+3TC AZT+ddI Ritonavir ddI+3TC AZT+ddc Nelfinavir d4T+ddI Efavirenz Nevirapine Saquinavir+Ritonavir Indinavir+Ritonavir Kaletrac
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2.Asymptomatic HIV infection
Drug of choice Alternative A B A B Indinavir Combivirb Abacavir AZT+3TC Saquinavir d4T+3TC AZT+ddI
Ritonavir ddI+3TC AZT+ddc
Nelfinavir d4T+ddI Efavirenz Nevirapine Saquinavir+Ritonavir Indinavir+Ritonavir Kaletrac
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3.Advanced HIV infection
Drug of choice Alternative A B A B Indinavir Combivirb Abacavir AZT+3TC Saquinavir d4T+3TC Nevirapine AZT+ddI Ritonavir ddI+3TC AZT+ddc
Nelfinavir d4T+ddI Efavirenz Nevirapine Saquinavir+Ritonavir Indinavir+Ritonavir Kaletrac
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4.HIV-infected pediatric patientsd
Drug of choice Alternative
A B A B Ritonavire AZTg+3TCe Abacavire AZTg+ddCe
Nelfinavirf AZTg+ddIf Nevirapinef d4Te+3TCe
d4Te+ddIf
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5.HIV infection in pregnant women
Drug of choice Alternative
A B A B
Nevirapine Combivir Nelfinavir AZT+3TC
Saquinavir AZT+ddI Indinavir d4T+3TC
Ritonavir
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6.Prophylaxis after occupational exposureh
Drug of choice Alternative
A B A B Indinavir Combivir Nelfinavir AZT+3TC
Saquinavir d4T+3TC
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Abbreviations:
d4T : Stavudine3TC: LamivudineAZT: ZidovudineddI: didanosineddC: ZalcitabineaAntiretroviral drug regimens are comprised ofone choice from column A and B.bCombivir: AZT+3TC.cKaletra: lopinavir/ritonavir.
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dAll regimens used for adults are also recommended for pediatrics.eOral solution formulation available.fPowder formulation for suspension available.gSyrup formulation available.hThe previous treatment regimens of source patie
nt should be taken into consideration; the duration of treatment is 4 weeks; the risk group should be considered, if contact with body fluid except blood, dual therapy is recommended.
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Developed by the Panel on Clinical Practices for Treatment of HIV infection convened by the Department of Health and Human Services (DHHS)
Guidelines for the Use of Antiretroviral Agents in
HIV-1 infected in Adults and Adolescents October 29, 2004
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It is emphasized that concepts relevant to HIV
management evolve rapidly. The panel has a
mechanism to update recommendations on a
regular basis, and the most recent information is
available on the AIDSinfo Web site.
(http:/AIDSinfo.nih.gov).
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Antiretroviral therapy is recommended for allpatients with history of an AIDS-defining illness or severe symptoms of HIV infection regardless of CD4+ T cells count.
Antiretroviral therapy is also recommended for asymptomatic patients with CD4+ T cells < 200/mm3.
When to treat: Indication for antiretroviral therapyPanel’s Recommendations
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Asymptomatic patients with CD4+ T cells counts of 201- 350/mm3 should be offered treatment. Asymptomatic patients with CD4+ T cells counts of >350/mm3 and plasma HIV RNA>100,000 copies/ml, most experienced clinicians defer therapy but some clinician consider initiating treatment.
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Therapy should be deferred for patients with CD4+ T cells counts of >350/mm3 and plasma HIV RNA<100,000 copies/ml.