Executive summary. Documento de consenso de Gesida/Plan Nacional sobre el Sida respecto al tratamiento antirretroviral en adultos infectados por el virus de la inmunodeficiencia humana (Actualización enero 2012)
2012; Elsevier BV; Volume: 30; Issue: 6 Linguagem: Inglês
ISSN
1695-4114
AutoresJuan Berenguer, Peré Domingo, Rosa Polo Rodríguez, Koldo Aguirrebengoa, Vicente Estrada Pérez, Félix Gutiérrez Rodero, Hernando Knobel, Josep Maria Llibre Codina, Celia Miralles Álvarez, José María Miró Meda, Antonio Rivero Román, Jesús Santos González, Montserrat Creus, Antonio Antela López, Víctor Asensi, José Ramón Arribas, José Ramón Blanco Ramos, Vicente Boix Martínez, E. Martínez Chamorro, Féderico García, José María Gatell Artigas, Josep Mallolas, Santiago Moreno, Rosario Palacios Muñoz, María Jesús Pérez‐Elías, J Vergara, Francesc Vidal, José López Aldeguer,
Tópico(s)Pneumocystis jirovecii pneumonia detection and treatment
ResumoIn the present update of the guidelines, starting antiretroviral treatment is recommended in symptomatic patients, in pregnant women, in sero-discordant couples with high transmission risk, in patients co-infected with hepatitis B requiring treatment and in patients with HIV-related nephropathy. Guidelines on combined antiretroviral treatment (cART) are included in the event of concurrent HIV infection diagnosis with an AIDS-defining event. In asymptomatic naive patients, cART will be based on CD4 lymphocyte count, plasma viral load (VL), patient age and patient comorbidity: (i) cART is recommended if CD4 count is lower than 350cells/µL; (ii) cART is equally recommended if CD4 count is between 350 and 500cells/µL and may only be deferred in the event of patient refusal with stable CD4 count and low VL; (iii) if CD4 count is higher than 500cells/µL cART can be delayed, but it may be considered in patients with liver cirrhosis, chronic virus C hepatitis, high cardiovascular risk, VL >105copies/mL, CD4 proportion lower than 14% and age over 55 years. cART in naive patients requires a combination of three drugs and its aim is to achieve undetectable VL. Treatment adherence plays a basic role in sustaining good response. cART could and should be changed if virologic failure occurs in order to achieve undetectable VL again. Approaches to cART in HIV acute infection, in women and pregnancy and post exposure prophylaxis are also commented on
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