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Guidelines For Using Antiretroviral Agents Among HIV-Infected Adults And Adolescents: The Panel On Clinical Practices For Treatment Of HIV*
M. Dybul, A. Fauci, J. Bartlett, J. Kaplan, A. Pau
Published 2002 · Medicine
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Time to take this seriously.
Introduction This report was developed by the Panel on Clinical Practices for Treatment of HIV (the Panel), which was convened by the Department of Health and Human Services (DHHS) and the Henry J. Kaiser Family Foundation in 1996. The goal of these recommendations is to provide evidence-based guidance for clinicians and other health-care providers who use antiretroviral agents in treating adults and adolescents infected with human immunodeficiency virus (HIV), including pregnant women. Although the pathogenesis of HIV infection and the general virologic and immunologic principles underlying the use of antiretroviral therapy are similar for all HIV-infected persons, unique therapeutic and management considerations exist for HIV-infected children. Therefore, guidance for antiretroviral therapy for pediatric HIV infection is not contained in this report. A separate report addresses pediatric-specific concerns related to antiretroviral therapy and is available at www.hivatis.org. These guidelines serve as a companion to the therapeutic principles from the National Institutes of Health (NIH) Panel To Define Principles of Therapy of HIV Infection (1). Together, the reports provide pathogenesis-based rationale for therapeutic strategies as well as guidelines for implementing these strategies. Although the guidelines represent the state of knowledge regarding the use of antiretroviral agents, this is an evolving science and the availability of new agents or new clinical data regarding the use of existing agents will change therapeutic options and preferences. Because this report needs to be updated periodically, a subgroup of the Panel on Clinical Practices for Treatment of HIV Infection, the Antiretroviral Working Group, meets monthly to review new data. Recommendations for changes are then submitted to the Panel and incorporated as appropriate. These recommendations are not intended to supersede the judgment of clinicians who are knowledgeable in the care of HIV-infected persons. Furthermore, the Panel recommends that, when possible, the treatment of HIV-infected patients should be directed by a clinician who has extensive experience in the care of these patients. When this is not possible, the patient should have access to such clinical experience through consultations. Each recommendation is accompanied by a rating that includes a letter and a Roman numeral (Table 1) and is similar to the rating schemes used in previous guidelines concerning prophylaxis of opportunistic infections (OIs) issued by the U.S. Public Health Service and the Infectious Diseases Society of America (2). The letter indicates the strength of the recommendation, which is based on the opinion of the Panel, and the Roman numeral reflects the nature of the evidence supporting the recommendation (Table 1). Thus, recommendations made on the basis of data from clinical trials with clinical results are differentiated from those made on the basis of laboratory results (e.g., CD4+ T lymphocyte count or plasma HIV ribonucleic acid [RNA] levels). When clinical trial data are unavailable, recommendations are made on the basis of the opinions of persons experienced in the treatment of HIV infection and familiar with the relevant literature. Table 1. Rating Scheme for Clinical Practice Recommendations Testing for Plasma HIV RNA Levels and CD4+ T Cell Count To Guide Decisions Regarding Therapy Decisions regarding initiation or changes in antiretroviral therapy should be guided by monitoring the laboratory parameters of plasma HIV RNA (viral load) and CD4+ T cell count in addition to the patient's clinical condition. Results of these laboratory tests provide clinicians with key information regarding the virologic and immunologic status of the patient and the risk for disease progression to acquired immunodeficiency syndrome (AIDS) (3, 4). HIV viral load testing has been approved by the Food and Drug Administration (FDA) for determining prognosis and for monitoring the response to therapy only for the reverse transcriptase-polymerase chain reaction (RT-PCR) assay and in vitro nucleic amplification test for HIVRNA (NucliSens HIV-1 QT, manufactured by Organon Teknika). Multiple analyses among >5000 patients who participated in approximately 18 trials with viral load monitoring indicated a statistically significant dose-responsetype association between decreases in plasma viremia and improved clinical outcome on the basis of standard results of new AIDS-defining diagnoses and survival. This relationship was observed throughout a range of patient baseline characteristics, including pretreatment plasma RNA level, CD4+ T cell count, and previous drug experience. Thus, viral load testing is an essential parameter in deciding to initiate or change antiretroviral therapies. Measurement of plasma HIV RNA levels (i.e., viral load) by using quantitative methods should be performed at the time of diagnosis and every 34 months thereafter for the untreated patient (AIII) (Table 2). CD4+ T cell counts should be measured at the time of diagnosis and every 36 months thereafter (AIII). These intervals between tests are recommendations only, and flexibility should be exercised according to the circumstances of each patient. Plasma HIV RNA levels should also be measured immediately before and again at 28 weeks after initiation of antiretroviral therapy (AIII). This second measurement allows the clinician to evaluate initial therapy effectiveness because, for the majority of patients, adherence to a regimen of potent antiretroviral agents should result in a substantial decrease ("1.0 log10) in viral load by 28 weeks. A patient's viral load should continue to decline during the following weeks and, for the majority of patients, should decrease below detectable levels (i.e., defined as <50 RNA copies/mL of plasma) by 1624 weeks. Rates of viral load decline toward undetectable are affected by the baseline CD4+ T cell count, the initial viral load, potency of the regimen, adherence to the regimen, previous exposure to antiretroviral agents, and the presence of any OIs. These differences must be considered when monitoring the effect of therapy. However, the absence of a virologic response of the magnitude discussed previously should prompt the clinician to reassess patient adherence, rule out malabsorption, consider repeat RNA testing to document lack of response, or consider a change in drug regimen. After the patient is receiving therapy, HIV RNA testing should be repeated every 34 months to evaluate the continuing effectiveness of therapy (AII). With optimal therapy, viral levels in plasma at 24 weeks should be undetectable (5). Data from clinical trials demonstrate that lowering plasma HIV RNA to <50 copies/mL is associated with increased duration of viral suppression, compared with reducing HIV RNA to levels of 50500 copies/mL (6). If HIV RNA remains detectable in plasma after 1624 weeks of therapy, the plasma HIV RNA test should be repeated to confirm the result and a change in therapy should be considered (see Changing a Failing Regimen) (BIII). Table 2. Indications for Plasma Human Immunodeficiency Virus (HIV) Ribonucleic Acid (RNA) Testing When deciding on therapy initiation, the CD4+ T lymphocyte count and plasma HIV RNA measurement should be performed twice to ensure accuracy and consistency of measurement (BIII). However, among patients with advanced HIV disease, antiretroviral therapy should be initiated after the first viral load measurement is obtained to prevent a potentially deleterious delay in treatment. The requirement for two measurements of viral load might place a substantial financial burden on patients or payers. Nonetheless, the Panel believes that two measurements of viral load will provide the clinician with the best information for subsequent patient follow-up. Plasma HIV RNA levels should not be measured during or within 4 weeks after successful treatment of any intercurrent infection, resolution of symptomatic illness, or immunization. Because differences exist among commercially available tests, confirmatory plasma HIV RNA levels should be measured by using the same laboratory and the same technique to ensure consistent results. A minimal change in plasma viremia is considered to be a threefold or 0.5-log10 increase or decrease. A substantial decrease in CD4+ T lymphocyte count is a decrease of >30% from baseline for absolute cell numbers and a decrease of >3% from baseline in percentages of cells (7). Discordance between trends in CD4+ T cell numbers and plasma HIV RNA levels was documented among 20% of patients in one cohort studied (8). Such discordance can complicate decisions regarding antiretroviral therapy and might be caused by factors that affect plasma HIV RNA testing. Viral load and trends in viral load are believed to be more informative for decision-making regarding antiretroviral therapy than are CD4+ T cell counts; however, exceptions to this rule do occur (see Changing a Failing Regimen). In certain situations, consultation with a specialist should be considered. Drug-Resistance Testing Testing for HIV resistance to antiretroviral drugs is a useful tool for guiding antiretroviral therapy. When combined with a detailed drug history and efforts in maximizing drug adherence, these assays might maximize the benefits of antiretroviral therapy. Studies of treatment-experienced patients have reported strong associations between the presence of drug resistance, identified by genotyping or phenotyping resistance assays, and failure of the antiretroviral treatment regimen to suppress HIV replication. Genotyping assays detect drug-resistance mutations that are present in the relevant viral genes (i.e., reverse transcriptase and protease). Certain genotyping assays involve sequencing of the entire reverse transcriptase and protease genes, whereas others use probes to detect selected mutations that are known to confer drug resistance. Genotyping ass
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High prevalence of avascular necrosis (AVN) of the hip in HIV infection: magnetic resonance imaging of 339 asymptomatic patients [Abstract 15]. Presented at the 38 Infectious Diseases
H Masur (2000)
Phenotypic resistance testing significantly improves response to therapy: a randomized trial (VIRA3001) [Abstract 237
C Cohen (2000)
Strategy of antiretroviral switch studies—a review [Abstract 1375]. Presented at the 40 th Interscience Conference on
Wg Powderly (2000)
Clinical factors related to the severity of fat redistribution in the HIV outpatient study (HOPS) [Abstract ThOrB704
K Lichtenstein (2000)
Male circumcision and HIV spread in sub-Saharan Africa [Abstract MoOrC192
A Buve (2000)
Dear Health Care Professional Letter—Re: Severe, life-threatening and fatal cases of hepatotoxicity with VIRAMUNE
Impact of directly observed therapy on outcomes in HIV clinical trials [Abstract 71
M Fischl (2000)
Modified directly observed therapy (MDOT) to enhance highly active therapy (HAART): 12 month follow-up [Abstract ThPeB4992
MS Stenzel (2000)
Factors influencing survival in HIV infected patients treated with HAART [Abstract TuOrB417
A Carmona (2000)
Adherence to antiretroviral therapy is associated with results of pills identification test [Abstract 793
JJ Parienti (2000)
Strategy of antiretroviral switch studies—a review [Abstract 1375
WG Powderly (2000)
Differences in anion gap with different nucleoside RTI combinations [Abstract 55]. Presented at the 7 Conference on Retroviruses and Opportunistic Infections
R Moore (2000)
Dear Health Care Professional Letter—Re: Severe, life-threatening and fatal cases of hepatotoxicity with VIRAMUNE®
Randomized open label trial of dietary advice with or without Pravastatin for the management of protease inhibitor (PI)-associated hypercholesterolemia [Abstract 1296]. Presented at the 40 th
Gj Moyle (2000)
Self-reported antiretroviral adherence correlates with HIV viral load and declines over time [Abstract TuOrB421
S Mannherheimer (2000)
High prevalence of avascular necrosis (AVN) of the hip in HIV infection: magnetic resonance imaging of 339 asymptomatic patients [Abstract 15]. Presented at the 38th Infectious Diseases
H Masur (2000)
Addition of a second protease inhibitor eliminates amprenavir-efavirenz interactions and increased amprenavir concentrations [Abstract 78
S Piscitelli (2000)
Patient adherence to highly active antiretroviral therapy for HIV-1 infection in a nation-wide cohort study in the Netherlands [Abstract MoPpD1055
P Nieuwkerk (2000)
Case-control study of avascular necrosis in HIV-infected patients
M Glesby (2000)
Adherence and viral load in HIV-infected drug users: comparison of self-report and medication events monitors (MEMS) [Abstract 69
J Arnsten (2000)
Do gender differences in viral load predict differences in HIV disease progression [Abstract 195]? Presented at the 7th Conference on Retroviruses and Opportunistic Infections
J Blair (2000)
Early initiation of combination antiretroviral therapy: does it affect long-term outcome [Abstract LbPeB7051]? Presented at the 13th International AIDS
J Kaplan (2000)
Early initiation of combination anti-retroviral therapy: does it affect long-term outcome [Abstract LbPeB7051]? Presented at the 13 th International AIDS Conference
J Kaplan (2000)
Osteopenia in a randomized, multicenter study of protease inhibitor (PI) substitution in patients with the lipodystrophy syndrome and wellcontrolled HIV viremia [Abstract 208
J Hoy (2000)
Factors associated with discontinuation of highly active antiretroviral therapy (HAART) in a large cohort of HIV-infected women [Abstract WePeB4293
L Ahdieh (2000)
Provider estimate (PE) and structured patient report of adherence compared with unannounced pill count [Abstract 70
DR Bangsberg (2000)
Do gender differences in viral load predict differences in HIV disease progression [Abstract 195]? Presented at the 7 th Conference on Retroviruses and Opportunistic Infections
J Blair (2000)
Correlation between antiretroviral pill burden and durability of virologic response [Abstract ThPeB4998
J Bartlett (2000)
Case-control study of avascular necrosis in HIVinfected patients
M Glesby (2000)
Hyperlactatemia and antiretroviral therapy in the Swiss HIV Cohort Study [Abstract 57
K Boubaker (2000)
Non-adherence to triple combination therapy is predictive of AIDS progression and death in HIV-positive men and women [Abstract TuOrB419
R Hogg (2000)
Randomized open label trial of dietary advice with or without Pravastatin for the management of protease inhibitor (PI)-associated hypercholesterolemia [Abstract 1296
GJ Moyle (2000)
Influence of low doses of ritonavir on the pharmacokinetics of nelfinavir 1250 mg BID [Abstract 1639
M Kurowski (2000)
Do gender differences in viral load predict differences in HIV disease progression [Abstract 195]? Presented at the 7 Conference on Retroviruses and Opportunistic Infections
J Blair (2000)
Lactic acidosis complicating antiretroviral therapy: frequency and correlates
M Harris (2000)
Adverse health events occurring during an N-9 gel pilot study: Malawi [Abstract TuPpC1171
I Hoffman (2000)
Differences in anion gap with different nucleoside RTI combinations [Abstract 55
R Moore (2000)
Coverage, adherence, and sustainability of antiretroviral therapy among injection drug users in Vancouver, Canada [Abstract ThPeB4990
M Tyndall (2000)
Serum and urine markers of bone mineral metabolism in HIVinfected patients taking protease inhibitor containing potent antiretroviral therapy
P Tebas (2000)
Early initiation of combination anti-retroviral therapy: does it affect long-term outcome [Abstract LbPeB7051]? Presented at the 13 International AIDS
J Kaplan (2000)
Community collaborations between physicians and pharmacists improves adherence with HIV Consensus Panel Guidelines (Guidelines) and enhances the care of HIV infected individuals [Abstract 800
AD Luber (2000)
Impact of directly observed therapy on outcomes in HIV clinical trials [Abstract 71]. Presented at the 7 Conference on Retroviruses and Opportunistic Infections
M Fischl (2000)
Osteopenia in a randomized, multicenter study of protease inhibitor (PI) substitution in patients with the lipodystrophy syndrome and well-controlled HIV viremia [Abstract 208
J Hoy (2000)
From lipodystrophy syndromes to diabetes mellitus
B. Joffe (2001)
Sex differences in nevirapine rash.
S. Bersoff-Matcha (2001)
Nevirapine and the risk of Stevens–Johnson syndrome or toxic epidermal necrolysis
J. Fagot (2001)
Virologic and immunologic consequences of discontinuing combination antiretroviral-drug therapy in HIV-infected patients with detectable viremia.
S. Deeks (2001)
Hepatotoxicity in HIV-1-infected patients receiving nevirapine-containing antiretroviral therapy
Esteban Martínez (2001)
Hyperlactatemia and antiretroviral therapy: the Swiss HIV Cohort Study.
K. Boubaker (2001)
Selenium Deficiency Is Associated With Shedding of HIV‐1‐Infected Cells in the Female Genital Tract
Jared M. Baeten (2001)
Altered Fat Distribution in HIV‐Positive Men on Nucleoside Analog Reverse Transcriptase Inhibitor Therapy
K. Mulligan (2001)
Female sex and the use of anti-allergic agents increase the risk of developing cutaneous rash associated with nevirapine therapy.
A. Antinori (2001)
Severe liver toxicity in patients receiving two nucleoside analogues and a non-nucleoside reverse transcriptase inhibitor
R. Gish (2001)
Risk factors for hepatotoxicity in patients treated with highly active antiretroviral therapy.
P. Bonfanti (2001)
ABT-378/ritonavir plus stavudine and lamivudine for the treatment of antiretroviral-naive adults with HIV-1 infection: 48-week results
R. Murphy (2001)
Bone mineral loss through increased bone turnover in HIV-infected children treated with highly active antiretroviral therapy
Stefano Mora (2001)
Risk Factors for Severe Hepatic Injury After Introduction of Highly Active Antiretroviral Therapy
M. Núñez (2001)
Rapid Communications: Failure of a Short‐Term Prednisone Regimen to Prevent Nevirapine‐Associated Rash: A Double‐Blind Placebo‐Controlled Trial: The GESIDA 09/99 Study
H. Knobel (2001)
Estrogen protects against vaginal transmission of simian immunodeficiency virus
Stephen M. Smith (2001)
Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy.
R. Hogg (2001)
Determinants of HIV-1 shedding in the genital tract of women
A. Kovacs (2001)
Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml.
J. Ioannidis (2001)
Altered fat distribution in hiv-positive men on nucleoside analog reverse transcriptase inhibitor therapy
K. Mulligan (2001)
Abacavir-lamivudine-zidovudine vs indinavir-lamivudine-zidovudine in antiretroviral-naive HIV-infected adults: A randomized equivalence trial.
S. Staszewski (2001)
Chronic hyperlactatemia in HIV-infected patients taking antiretroviral therapy
Mina John (2001)
Initial plasma HIV-1 RNA levels and progression to AIDS in women and men.
T. Sterling (2001)
Antiretroviral Treatment Simplification With Nevirapine in Protease Inhibitor‐Experienced Patients With HIV‐Associated Lipodystrophy: 1‐Year Prospective Follow‐Up of a Multicenter, Randomized, Controlled Study
L. Ruiz (2001)
Understanding the timing of HIV transmission from mother to infant.
A. Kourtis (2001)
Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).
S. Grundy (2001)
and the Swiss HIV Cohort Study. Clinical benefit of early initiation of HAART in patients with asymptomatic HIV and CD4 counts 350/mm3 [Abstract LB6
M Opravil (2001)
Prognosis of HIV-1 infected drug naïve patients starting potent antiretroviral therapy: multicohort analysis of 12,040 patients [Abstract LB-18
M Egger (2001)
Randomized controlled trial on intermittent versus continuous HAART [Abstract 364]. Presented at the 8 Conference on Retroviruses and Opportunistic Infections
M Dybul (2001)
Randomized double-blind study of Gemfibrozil (GF) for the treatment of protease inhibitorassociated hypertriglyceridaemia [Abstract 540
J Miller (2001)
Confidence in HAART and recent unprotected anal sex among men who have sex with men (MSM) [Abstract 213
T Bingham (2001)
Avascular necrosis of the hip (Leggs-Calve-Perthes Disease [LCPD]) in HIV-infected children in long-term follow up: PACTG Study 219 [Abstract 638
DM Gaughan (2001)
of Health and Human Services
US Departmen (2001)
Randomized double-blind study of Gemfibrozil (GF) for the treatment of protease inhibitor-associated hypertriglyceridaemia [Abstract 540
J Miller (2001)
Long-term survival after initiation of antiretroviral therapy [Abstract 341]. Presented at the 8 Conference on Retroviruses and Opportunistic Infections
R Chen (2001)
Abstract 6. Presented at the 3 International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
K. Yarasheski (2001)
Long-term survival after initiation of antiretroviral therapy [Abstract 341
R Chen (2001)
Healthcare provider important drug warning
Bristol-Myers Squibb Company (2001)
Randomized controlled trial on intermittent versus continuous HAART [Abstract 364
M Dybul (2001)
Abstracts 1 and 2. Presented at the 3 International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
H Murata (2001)
Unsafe sex among persons in HIV care is associated with decreased adherence with antiretroviral therapy [Abstract 214
R Flaks (2001)
Sex difference in nevirapine rash
SJ Bersoff-Matcha (2001)
for the EuroSCAR Study Group. Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis
Jp Fagot (2001)
CD4 lymphocyte level is better than HIV-1 plasma viral load in determining when to initiate HAART [Abstract 519]. Presented at the 8 Conference on Retroviruses and Opportunistic Infections
TR Sterling (2001)
Prognosis of HIV-1 infected drug naı̈ve patients starting potent antiretroviral therapy: multicohort analysis of 12,040 patients [Abstract LB-18
M Egger (2001)
SSITT: a prospective trial of strategic treatment interruptions in 128 patients [Abstract 357
C Fagard (2001)
Avascular necrosis of the hip (Leggs-Calve-Perthes Disease [LCPD]) in HIV-infected children in longterm follow up: PACTG Study 219 [Abstract 638
DM Gaughan (2001)
Male circumcision as an effective HIV prevention strategy: current evidence [Abstract S22
R. Bailey (2001)
Abstract 6. Presented at the 3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
K. Yarasheski (2001)
Abstracts 1 and 2. Presented at the 3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
H Murata (2001)
Healthcare Provider Important Drug Warning Letter
Bristol-Myers Squibb Company (2001)
Clinical benefit of early initiation of HAART in patients with asymptomatic HIV and CD4 counts >350/mm 3 [Abstract LB6]
M Opravil (2001)
Guidelines for preventing opportunistic infections among HIV-infected persons--2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America.
J. Kaplan (2002)
Guidelines for using antiretroviral agents among HIV-infected adults and adolescents. Recommendations of the Panel on Clinical Practices for Treatment of HIV.
M. Dybul (2002)
U.S. Public Health Service Task Force recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States.
L. Mofenson (2002)
Guidelines for preventing opportunistic infections among HIV-infected persons - 2002
H. Masur (2002)
A randomized, double-blind study of gemfibrozil for the treatment of protease inhibitor-associated hypertriglyceridaemia
John C. Miller (2002)
Supplement Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents
triazolam: Temazepam, lorazepam. Recommendations and Reports May 17
Survival of a human immunodeficiency patient with nucleoside-induced Supplement Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents
R Chodock (2002)
Supplement Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents www.annals.org
GJ Weverling (2002)
After reading this report, I am confident I can describe considerations for using antiretroviral therapy among pregnant women. A. Strongly agree. B. Agree. C. Neither agree nor disagree
D. Conference presentation
To receive continuing education credit, please answer all of the following questions. 9. Methods to improve adherence include . . . A. chastising patients for failing to take medications
After reading this report, I am confident I can describe considerations for changing therapy and available therapeutic options. A. Strongly agree. B. Agree. C. Neither agree nor disagree
In the reference study, AIDS was defined according to the 1987 CDC definition, which did not include asymptomatic persons with CD4 + T cell counts <200 mm 3
D. assess readiness for treatment
Drug resistance testing is recommended for . . . A. pregnant woman who are initiating antiretroviral therapy. B. patients with chronic, asymptomatic HIV infection before therapy
This effect probably applies to the entire class
C. three NRTIs to spare a PI or NNRTI
Reviewing remaining treatment options
Hospital clinic/private practice
B. obtain hematology and chemistry panels, lipid levels, assays for possible coinfections, and CD4 + T cell count (two levels, if possible)
D. More than 2.5 hours
D. public policy. E. other
Suboptimal suppression of plasma viremia after initiating a regimen
After reading this report, I am confident I can describe considerations for initiating antiretroviral therapy. A. Strongly agree. B. Agree. C. Neither agree nor disagree
C. local practice guidelines
B. insurance reimbursement policies
Rifabutin: Clarithromycin, azithromycin (Mycobacterium avium-intracellulare prophylaxis); clarithromycin, ethambutol (Mycobacterium avium-intracellulare treatment)
D. all of the above
How much time did you spend reading this report and completing the exam? A. 1–1.5 hours. B. More than 1.5 hours but fewer than 2 hours. C. 2–2.5 hours
C. patients with suboptimal viral load suppression after initiation of HAART
E. perform all of the above Goal and Objectives This MMWR provides recommendations for the use of antiretroviral therapy among adults and adolescents infected with human immunodeficiency virus (HIV)
Strongly disagree. 28. Overall, the presentation of the report enhanced my ability to understand the material. A. Strongly agree. B. Agree. C. Neither agree nor disagree
These recommendations will affect my practice. A. Strongly agree. B. Agree. C. Neither agree nor disagree
B. two NRTIs and the NNRTI efavirenz or >1 PIs
D. patients with clinical evidence of drug failure before changing or interrupting the antiretroviral drugs
I plan to use these recommendations as the basis for . . . (Indicate all that apply.) A. health education materials
Check One CME Credit CNE Credit CEU Credit CE-4 MMWR May 17, 2002 Correct answers for questions
A. State/local health department
Too few subjects were in this category to provide a reliable estimate of AIDS risk
Patient care — primary-care clinic or office
Other public health setting
The tables and figure are useful. A. Strongly agree. B. Agree. C. Neither agree nor disagree
C. obtain plasma HIV ribonucleic acid (RNA) measurements (two levels, if possible)
Gregg Gonsalves, Gay Men's Health Crisis University of Pittsburgh Medical Center New York State Department of Health
M D Carpenter
Indicate your work setting
After reading this report, I am confident I can describe use of testing for antiretroviral drug resistance. A. Strongly agree. B. Agree. C. Neither agree nor disagree
B. Systemic or specific toxicity
Rifampin: Rifabutin (Mycobacterium tuberculosis) Astemizole, terfenadine: Loratadine, fexofenadine, cetirizine
E. Public health. F. Other
How did you learn about this continuing education activity? A. Internet. B. Advertisement (e.g., fact sheet, MMWR cover, newsletter, or journal)
Each month, approximately how many HIV-infected patients do you treat? A
After reading this report, I am confident I can describe optimal adherence to antiretroviral therapy. A. Strongly agree. B. Agree. C. Neither agree nor disagree
Which best describes your professional activities? A. Patient care — emergency/urgent care department. B. Patient care — inpatient
Which class of antiretroviral drugs is most likely to be associated with lactic acidosis and hepatic steatosis? A
C. ongoing patient education and after-hours access to health-care providers
If a patient takes St. John's wort for depression, which of the following antiretroviral drugs is it most likely to affect by decreasing plasma levels? A
B. supporting and reinforcing the need for optimal adherence
Before initiating HAART, the health-care provider should . . . A. confirm HIV results
Detach or photocopy
The objectives are relevant to the goal of this report. A. Strongly agree. B. Agree. C. Neither agree nor disagree
E. Academic institution. F. Other
After reading this report, I am confident I can describe considerations for using antiretroviral therapy among adolescents. A. Strongly agree. B. Agree. C. Neither agree nor disagree
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An assessment of the reproducibility of reverse transcription digital PCR quantification of HIV-1.
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Patients of COVID-19 may benefit from sustained Lopinavir-combined regimen and the increase of Eosinophil may predict the outcome of COVID-19 progression
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FDA approved drugs with pharmacotherapeutic potential for SARS-CoV-2 (COVID-19) therapy
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Drug Interactions of Psychiatric and COVID-19 Medications
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Depressive Disorders and Incidence of COVID-19: Is There a Correlation and Management Interference?
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A discrete choice experiment to assess patients’ preferences for HIV treatment in the rural population in Colombia
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A discrete choice experiment to assess patients’ preferences for HIV treatment in the urban population in Colombia
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Analisi degli elementi organizzativi nella disposizione di Offerta di test HIV rapidi. Il caso dell’Associazione Odv Casa Arcobaleno.
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Factors Influencing Viral Load Non-suppression among People Living with HIV (PLHIV) in Borno State, Nigeria: A Case of Umaru Shehu Ultra-Modern Hospital
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Antiviral Therapies: A Critical Reappraisal
Ahmed Elsanhoury (2020)
The HIV drug optimization agenda: promoting standards for earlier investigation and approvals of antiretroviral drugs for use in adolescents living with HIV
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Psychosocial Well-Being and HIV-Related Immune Health Outcomes among HIV-Positive Older Adults: Support for a Biopsychosocial Model of HIV Stigma and Health
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Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study
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Microbiological study of the subgingival biofilm in HIV+/HAART patients at a specialized dental service.
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Effects of Nonadherence to HIV/AIDS Drugs on HIV-Related Comorbidities in Eastern Nigeria
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HIV Genotype and Phenotype Testing
On restricted optimal treatment regime estimation for competing risks data.
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Linked dual-class HIV resistance mutations are associated with treatment failure.
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Climate Crisis Impact on AIDS, IRIS and Neuro-AIDS
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Time factor in antiretroviral adherence: analysis of adherence to single-tablet regimens versus multiple-tablet regimens over a 5-year period
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Assessment of tenofovir-induced nephrotoxicity development and recovery in HIV patients on TDF based regimens at Kenyatta National Hospital comprehensive care clinic
Walter O Owako (2018)
Management of Human Immunodeficiency Virus in the Emergency Department.
M. Torres (2018)
The impact of CYP2B6 polymorphisms on the interactions of efavirenz with lumefantrine: Implications for paediatric antimalarial therapy
Zaril H Zakaria (2018)
HIV infection and lipids
Anjly Jain (2018)
Virological failure on first-line antiretroviral therapy; associated factors and a pragmatic approach for switching to second line therapy–evidence from a prospective cohort study in rural South-Western Uganda, 2004-2011
P. Kazooba (2018)
Structural Covariance of Gray Matter Volume in HIV Vertically Infected Adolescents
Jielan Li (2018)
Analysis of Organizational Elements in the Arrangement of HIV Rapid Tests Offer
Biancone P.P. (2018)
Molecular dynamics study of HIV-1 protease inhibitors and their effects on the flap dynamics of the HIV-1 subtype-C (C-SA).
S. Maphumulo (2018)
Estimation Procedures for Complex Survival Models and Their Applications in Epidemiology Studies
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