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Ebook ABC of AIDS (5/E): Part 2

Part 2 book “ABC of AIDS” has contents: Treatment of infections and antiviral therapy, HIV infection and AIDS in the developing world, injection drug use-related HIV infection, control of infection policies, strategies for prevention, and other contents. | 9 Treatment of infections and antiviral therapy Ian VD Weller, IG Williams The treatment of HIV infection can be largely divided into: (i) specific antiviral agents that inhibit viral replication, (ii) measures that either treat or prevent (prophylaxis) its complications – namely opportunistic infections and tumours. Major advances in the treatment of HIV infection have occurred in the last few years. This has resulted in marked falls in the reported number of new AIDS cases and deaths in the developed world since 1996. Effective antiretroviral therapy regimens which substantially inhibit HIV replication and allow sustained improvements in the immune system are the main reason for this. There are currently three classes of antiretroviral agents: the nucleoside and non-nucleoside reverse transcriptase inhibitors and the protease inhibitors. Improved formulations and new drugs are continuously being evaluated and there is increasing interest in the possible role of immunotherapy combined with antiretroviral therapy to improve specific immune responses. However, in those who are severely immunosuppressed the treatment and prophylaxis of opportunistic infections remains important. Though it cannot be overemphasised that the most effective way to prevent first episodes or recurrences of opportunistic infections is treatment with antiretroviral drugs. This chapter will cover both antiretroviral therapy and the treatments of the infections previously described in other parts of this book, in an attempt to bring all of these together in a comprehensive manner. Box 9.1 Treatment strategies in HIV disease • • • Antiretroviral therapy: suppresses viral replication results in immune reconstitution Prophylaxis of opportunistic infections Prevent exposure to opportunistic pathogens Protozoal infections Pneumocystis carinii pneumonia (PCP) Although recently recognised as being more like a fungus, P. carinii is considered under protozoa here. Nowadays PCP most commonly .