State-of-the-Art HIV Management:An Update

Within the past 3 years, dramatic changes have taken place in the standard of care for HIV patients. Despite improvements in care (with decreased mortality), the rate of new infections remains unchanged if not increased within most at-risk groups. This general overview is intended for the physician who, while not providing ongoing HIV care, desires an update on the major treatment issues. Current demographic trends, new methods available for testing, and the use of the viral load test for both staging and gauging response to the new combination antiretroviral treatment regimens are detailed. It is suggested that physicians consult with an experienced HIV clinician before starting a treatment regimen in the newly diagnosed patient.The primary HIV syndrome is reviewed in detail since this diagnosis is often missed and an opportunity for early intervention is lost. Physicians not providing ongoing HIV care must be comfortable making this diagnosis and doing an initial work-up. Focused prevention especially tailored to younger high-risk patients is reviewed. Treatment protocols (with an emphasis on new antiretrovirals), gauging success of treatment, and the management of treatment failures are reviewed in detail. Common antiretroviral drugs are listed with side effects, drug interactions, and average monthly costs. Care of pregnant patients and exposed healthcare workers is also briefly discussed. The need for more primary care-based prevention is also discussed.