- Despite a vast amount of new trial data, we still
do not know for sure when to treat.
- Standard of care is sub-optimal when one considers
virological failure, compliance and toxicity problems. Treatment is the best guess
according to individual needs. There are still often no 1-2 year data to help beyond the
- Since the last World AIDS Conference in Vancouver
(1996) the messages about antiviral treatments have become more complex and uncertain.
Antiretroviral therapy - New
drugs and regimens
- Abacavir (1592) is a nucleoside inhibitor of the
Results presented showed that a
combination of AZT-3TC-abacavir is superior to AZT-3TC.
Abacavir is safe and well
tolerated in adults. The drug has a potent effect after 16 weeks of treatment. However,
the study is recent and has a short follow-up.
A study in children with prior
antiretroviral therapy indicate a diminished response in these patients. The
hypersensitivity syndrome associated with abacavir does not seem to be more common in
children than in adults.
- Efavirenz-AZT-3TC is a potential candidate for
first line therapy. It is better tolerated and at least as potent as the existing standard
of care (AZT-3TC-indinavir).
- Ritonavir plus saquinavir was found to be better
than either ritonavir or indinavir added to one or two nucleoside analogues of the HIV
retrotranscriptase in protease-na´ve patients.
Highly active antiretroviral therapy (HAART)
suppresses CMV replication.
Withdrawal of CMV maintenance therapy can lead to
There are conflicting studies reporting about
whether HAART is associated with hepatic failure.
Strengthen the continuity of care for the patients
into the home setting.
Present type of care varies according to the
Care in resource-limited setting
The main issues remain :
- Facilities such as clean water, hospital beds and
health care system infrastructure;
- Personnel - skills in care;
- Ethical issues and in particular confidentiality;
- Discrimination and stigmatisation.
Progress was reported in the following areas :
- Training in various care aspects such as
- Increase access to home care;
- Improvement in survival of HIV+ persons;
- Evolution of care models;
- Increasing partnership between NGOs and
- Community acceptance.
The challenges which remain to be tackled :
- Increasing number of HIV+ people;
- Treatment of opportunistic infections;
- Limited access to voluntary testing;
- Increasing number of AIDS-related deaths.
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