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Tb therapy guidelines


For those types of questions, we recommend that you contact a licensed care provider, a representative of a social service agency, or a public health organization in your community.(III) In typical clinical practice, durable suppression of viral replication to undetectable levels may be achieved in approximately 80% of cases.Public health guidance currently recommends that all patients living with HIV be treated with ART to reduce transmission of HIV in a strategy commonly known as “treatment as prevention.” This Committee strongly supports the idea of treatment as prevention.3.Patients with seronegative partners should be counseled about the reduction of HIV transmission risk when effective ART is initiated; ART is strongly recommended in patients with seronegative partners.Patients who are unable to adhere strictly to complex medication regimens are those most likely to develop HIV-drug resistance and to face limited future ART options (see Section IV: This recommendation is based on evidence that patients with established HIV infection benefit from ART at all stages of disease and on recent data that demonstrate a dramatic reduction of HIV transmission risk from ART-treated patients.back to top Antiretroviral therapy (ART) refers to the use of pharmacologic agents that have specific inhibitory effects on HIV replication.back to top Clinicians should prescribe an ART regimen that is best able to delay disease progression, prolong survival, and maintain quality of life through maximal viral suppression (see Table 1).To find resources, we suggest starting with the website of the New York State Department of Health AIDS Institute, which provides an extensive list of resources for people living with HIV/AIDS.The commercially available antiretroviral drugs that are approved by the Food and Drug Administration (FDA) for the treatment of HIV/AIDS are listed in Appendix A.Please refer to the April 2015 update of the DHHS guideline for the most current information on antiretroviral therapy for adults.The maximal suppression of viral replication is generally associated with gradual increases in the CD4 count and clinical stabilization or improvement of HIV-associated symptoms.When maximal suppression is not attainable due to the inability to construct an effective regimen for the patient, partial viral suppression (≥0.5 log reduction, or 3-fold, from baseline viral load value) and stable CD4 counts are reasonable alternative goals.As of September 2015, this guideline is under review.

These agents belong to six distinct classes of drugs: the nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs, Nt RTIs), the non-nucleoside reverse transcriptase inhibitors (NNRTIs), the protease inhibitors (PIs), the fusion inhibitors (FIs), the CCR5 co-receptor antagonists, and the integrase strand transfer inhibitors (INSTIs).The use of less than three active agents is not recommended for initiating treatment.(I) The clinician should involve the patient in the decision-making process when determining whether to implement ART.The clinician should review the benefits and risks of treatment for each individual patient.However, incomplete suppression of viral replication may be associated with continued immunologic and clinical deterioration and the evolution of additional resistance mutations.


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