Skip to Main Content

With improvements in therapy, patients who are compliant with treatment should have near normal life spans. A population-based study conducted in Denmark found that HIV-infected persons at age 25 years without hepatitis C had a life expectancy similar to that of an uninfected 25-year-old. Unfortunately, not all HIV-infected persons have access to treatment. Studies consistently show less access to treatment for blacks, the homeless, and injection drug users. For patients whose disease progresses even though they are receiving appropriate treatment, meticulous palliative care must be provided (see Chapters 5-10, 5-11, 5-12, and 5-13), with attention to pain control, spiritual needs, and family (biologic and chosen) dynamics.

WHEN TO REFER

  • HIV-infected patients in whom viral loads cannot be fully suppressed on one of the initial recommended regimens should be referred to specialists.

  • Specialty consultation is particularly important for those patients with detectable viral loads on antiretroviral treatment; those intolerant of standard medications; those in need of systemic chemotherapy; and those with complicated opportunistic infections, particularly when invasive procedures or experimental therapies are needed.

WHEN TO ADMIT

Patients with opportunistic infections who are acutely ill (eg, who are febrile, who have had rapid change of mental status, or who are in respiratory distress) or who require intravenous medications.

+
Cahn  P  et al; GEMINI Study Team. Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials. Lancet. 2019 Jan 12;393(10167):143–55. Erratum in: Lancet. 2018 Nov 28.
[PubMed: 30420123]  
+
Emu  B  et al. Phase 3 study of ibalizumab for multidrug-resistant HIV-1. N Engl J Med. 2018 Aug 16;379(7):645–54.
[PubMed: 30110589]  
+
Gallant  J  et al. Bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir, abacavir, and lamivudine for initial treatment of HIV-1 infection (GS-US-380-1489): a double-blind, multicenter, phase 3 randomised controlled non-inferiority trial. Lancet. 2017 Nov 4;390 (10107):2063–72.
[PubMed: 28867497]  
+
Gulick  RM. Investigational antiretroviral drugs: what is coming down the pipeline. Top Antivir Med. 2018 Apr;25(4):127–32.
[PubMed: 29689540]  
+
Johnson  SC. Antiretroviral therapy for HIV infection: when to initiate therapy, which regimen to use, and how to monitor patients on therapy. Top Antivir Med. 2016 Dec–2017 Jan; 23(5):161–7.
[PubMed: 27398769]  
+
Kalapila  AG  et al. Antiretroviral therapy for prevention of human immunodeficiency virus infection. Med Clin North Am. 2016 Jul;100(4):927–50.
[PubMed: 27235622]  
+
Kanters  S  et al. Comparative efficacy and safety of first-line antiretroviral therapy for the treatment of HIV infection: a systematic review and network meta-analysis. Lancet HIV. 2016 Nov;3(11):e510–20.
[PubMed: 27658869]  
+
Kanters  S  et al. Comparative efficacy and safety of second-line antiretroviral therapy for treatment of HIV/AIDS: a systematic review and network meta-analysis. Lancet HIV. 2017 Oct;4(10):e433–441.
...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.