The treatment of patients with HIV

Abstract

Background: Infection with the human immunodeficiency virus (HIV) remains a major medical challenge.

Methods: Selective literature review, including the current German/Austrian, European, and American guidelines on the treatment of HIV infection in adults.

Results: In Germany, 3000 persons become infected with HIV each year; in 2009, 67,000 persons in Germany were living with HIV. When highly active antiretroviral therapy (HAART) is initiated in time, patients can achieve a nearly normal life expectancy. Nonetheless, in Germany as elsewhere, 30% of patients receive the diagnosis of HIV infection only when they have reached the AIDS stage of the disease or are suffering from advanced immunodeficiency. HAART should be started, at the latest, when the CD4-positive helper cell count drops below 350/microL. Primary drug resistances, accompanying illnesses, and the patient's living circumstances must all be taken into account in the selection of antiretroviral drugs. The goal of treatment is lasting suppression of HIV-RNA to below 50 copies per milliliter of plasma.

Conclusions: HIV testing should be offered to all patients at high risk for HIV infection and all persons newly diagnosed with a sexually transmitted disease. As persons with HIV grow older, their treatment is complicated by increasing comorbidity and requires increased vigilance for possible drug interactions.

Figure: HIV/AIDS-associated diseases

(a) 20% to 50% of patients with an acute retroviral infection have a characteristic maculopapular rash that is most prominent on the trunk. (b) Herpes zoster on the chest. (c) Petechiae and bruises in HIV-associated thrombocytopenia. (d) EBV-associated oral hairy leukoplakia. (e) HIV-associated thrush (oral candidiasis). (f) Active (soft) foci of Kaposi’s sarcoma on the back.