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, palliative care must be provided (see Chapter 5), with attention to pain control, spiritual needs, and family (biologic and chosen) dynamics.
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.
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.
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;393:143.
et al. Phase 3 study of ibalizumab for multidrug-resistant HIV-1. N Engl J Med. 2018;379:645.
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;390:2063.
et al. Fostemsavir in adults with multidrug-resistant HIV-1 infection. N Engl J Med. 2020;382:1232.
Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/Adult_OI.pdf
. Updated 2020 May 26.
et al. Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomized, open-label, phase 2b, non-inferiority trial. Lancet. 2017;390:1499.
et al; DRIVE-FORWARD Study Group. Doravirine versus ritonavir-boosted darunavir in antiretroviral-naive adults with HIV-1 (DRIVE-FORWARD): 48-week results of a randomised, double-blind, phase 3, non-inferiority trial. Lancet HIV. 2018;5:e211.
et al. Nucleoside reverse transcriptase inhibitor-reducing strategies in HIV ...