antiretroviral%20therapy%20for%20hiv-infected%20adults
ANTIRETROVIRAL THERAPY FOR HIV-INFECTED ADULTS
Treatment Guideline Chart
Antiretroviral therapy is recommended for all HIV-infected individuals regardless of CD4 count to decrease morbidity and mortality associated with HIV infection.
Goals of antiretroviral treatment are suppression of viral load for maximum possible duration, restore and preserve immunologic function, reduce HIV-related morbidity and mortality and prevent HIV transmission.
Urgent initiation of antiretroviral treatment is recommended in the following individuals: Pregnant women, patients with HIV with coinfections (HBV, HCV, active tuberculosis), AIDS-defining illness, HIV-associated nephropathy, low CD4 counts, acute opportunistic infections and HIV HBV with evidence of chronic liver disease.

Antiretroviral%20therapy%20for%20hiv-infected%20adults Signs and Symptoms

Introduction

  • Human immunodeficiency virus (HIV) is a single-stranded ribonucleic acid (RNA) virus recognized as the causative agent of acquired immunodeficiency syndrome (AIDS)
  • Types of HIV epidemics:
    • Low-level epidemic is when HIV may have existed for many years but has never spread to significant levels in any sub-population; recorded infection is largely confined to high-risk individuals [eg drug injectors, sex workers, men having sex with other men (MSM)]; HIV prevalence has not consistently exceeded 5% in any sub-population
    • Concentrated HIV epidemics is when HIV has spread rapidly in a defined sub-population but is not well established in the general population; HIV prevalence is consistently >5% in at least one sub-population but is <1% in pregnant women in urban areas
    • Generalized HIV epidemic is when HIV is firmly established in the general population; HIV prevalence is consistently >1% in pregnant women

Epidemiology

  • Globally, as of 2021, reported cases to the World Health Organization (WHO) were approximately 38.4 million (33.9–43.8 million), with an estimated 3.8 million people coming from South-East Asia
  • There have been 40.1 million deaths reported to the WHO globally as of 2021, with 650,000 (510,000-860,000) deaths due to HIV-related causes
  • In the Philippines, people living with HIV were estimated at 140,000 in 2021, at 520,000 in Thailand in 2021, at 540,000 in Indonesia in 2021, and at 87,581 (77,910-98,007) in Malaysia in 2019
  • A cumulative total of 10,785 HIV cases in Hong Kong have been recorded in 2020, with the median age of 37 years (30-39 years old in males; 40-49 years old in females) and are mostly male (83%)

Pathophysiology

  • The outer viral membrane which contains HIV-specific glycoproteins (gp) including gp120 and gp41, facilitates attachment and entry of HIV into the host's CD4+ cells
  • CD4+ T cell destruction is the hallmark of HIV infection
  • Viral replication progresses with the presence of 2 key enzymes: Reverse transcriptase and integrase
    • Reverse transcriptase: Forms viral RNA to viral DNA
    • Integrase: Transports viral DNA into the nucleus to integrate with human chromosomal DNA
  • B cell proliferation and abnormal antibody production impairs humoral immunity
  • Ongoing viremia with pro-inflammatory cytokines, B cell proliferation, and hypergammaglobulinemia leads to a chronic inflammatory state that contributes to cardiovascular disease, cancer, and other chronic diseases
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