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  • Image not available. Infection with human immunodeficiency virus (HIV) occurs through three primary modes: sexual, parenteral, and perinatal. Sexual intercourse, primarily receptive anal and vaginal intercourse, is the most common method for transmission.
  • Image not available. HIV infects cells expressing cluster of differentiation 4 (CD4) receptors, such as T-helper lymphocytes, monocytes, macrophages, dendritic cells, and brain microglia. Infection occurs via an interaction between glycoprotein 120 on HIV with CD4 (primary interaction) and chemokine co-receptors (secondary interactions) present on the surfaces of these cells.
  • Image not available. The hallmark of untreated HIV infection is profound CD4 T-lymphocyte depletion and severe immunosuppression that puts patients at significant risk for infectious diseases caused by opportunistic pathogens. Opportunistic infections in settings without access to antiretroviral drugs are the chief cause of morbidity and mortality associated with HIV infection.
  • Image not available. General principles for the management of opportunistic infections include preventing or reversing immunosuppression with antiretroviral therapy, preventing exposure to pathogens, vaccination, prospective immunologic monitoring, primary chemoprophylaxis, treatment of acute episodes, secondary chemoprophylaxis, and discontinuation of such prophylaxes following antiretroviral therapy and subsequent immune recovery.
  • Image not available. Eradication of HIV is not possible at this time. Therefore, the goal of antiretroviral therapy is to achieve maximal and durable suppression of HIV replication, interpreted to be a sustained plasma viral load less than the lower limit of quantitation. Another equally important outcome is an increase in CD4 lymphocytes because this closely correlates with the risk for developing opportunistic infections.
  • Image not available. Current recommendations for the initial treatment of HIV advocate a minimum of three active antiretroviral agents from at least two drug classes. The typical regimen consists of two nucleoside analogs with either a protease inhibitor (pharmacologically enhanced with low-dose ritonavir), a nonnucleoside reverse transcriptase inhibitor, or an integrase inhibitor.
  • Image not available. Clinical use of antiretroviral agents is complicated by drug–drug interactions. Some interactions are beneficial and used purposely; others may be harmful, leading to dangerously elevated or inadequate drug concentrations. For these reasons, clinicians involved in the pharmacotherapy of HIV infection must exercise constant vigilance and maintain a current knowledge of drug interactions.
  • Image not available. Inadequate suppression of viral replication allows HIV to select for antiretroviral-resistant HIV variants, the major factor limiting the ability of antiretroviral drugs to inhibit virus replication and delay disease progression.
  • Image not available. Current recommendations for treating drug-resistant HIV include choosing at least two drugs (preferably three) to which the patient’s virus is susceptible. Susceptibility can be assessed using either (virtual) genotypic or phenotypic resistance testing.
  • Image not available. The longer life span conferred by antiretroviral treatment has given rise to new medical issues. First, a wide spectrum of early aging complications have become common, some of which are adverse effects from antiretroviral drugs. Second, hepatitis C virus coinfection has emerged as an important cause of morbidity and mortality. Medical management of these contemporary HIV complications is constantly evolving.

Upon completion of the chapter, the reader will be able to:

  • 1. Characterize the modes, factors, and preventative measures associated with HIV transmission.
  • 2. Compare and contrast the HIV epidemic in the United States versus other ...

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