Antiretroviral therapy in HIV-infected adults who are treatment naive (have not previously received antiretroviral therapy) should be initiated with a potent multiple-drug regimen. Treatment should be aggressive with the goal of maximal suppression of viral load to undetectable levels.
Author: Brian Holtry
Hepatic Effects and Lactic Acidosis
Lactic acidosis and severe hepatomegaly with steatosis, including fatalities, have been reported in patients receiving NRTIs (abacavir, didanosine, emtricitabine, lamivudine, stavudine, zalcitabine, zidovudine).
Guidelines for Use of Antiretroviral Agents
The choice of antiretroviral agents to include in the initial regimen used in HIV-infected individuals who are treatment naive (have not previously received antiretroviral therapy) and the most appropriate agents to use in subsequent regimens in previously treated individuals must be individualized based on virologic, immunologic, and clinical characteristics of the individual patient.
General Principles of Antiretroviral Therapy
Effective management of the disease must be based on updated information related to the biology and pathogenesis of HIV infection, currently available antiretroviral agents, clinical status of the patient.
Classification of Antiretroviral Agents
Antiretroviral agents are synthetic antiviral agents that have antiviral activity against human immunodeficiency virus (HIV) and are used in the management of HIV infection. There currently are 5 different classes of antiretroviral agents commercially available: nucleoside reverse transcriptase inhibitors (NRTIs), HIV protease inhibitors, nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleotide reverse transcriptase inhibitors, and HIV fusion inhibitors.
Rimantadine Hydrochloride
While the optimum dose and duration of therapy have not been established, rimantadine also has been used for the treatment of influenza A virus infection in children. While chemoprophylaxis with the drug should not be considered a substitute for annual vaccination with influenza virus vaccine, antiviral agents are an important adjunct to influenza vaccine for the control and prevention of influenza.
Dapsone (Aczone)
The most frequent adverse effects of dapsone are dose-related hemolytic anemia and methemoglobinemia. Hemolysis occurs in most patients receiving 200 mg or more of dapsone daily; however, symptomatic anemia occurs only occasionally. The manufacturer states that the hemoglobin level is generally decreased by 1-2 g/dL, the reticulocyte count is increased 2-12%, erythrocyte life span is shortened, and methemoglobinemia occurs in most patients receiving dapsone. Heinz body formation also occurs frequently.
Lamprene (Clofazimine)
Clofazimine is administered orally. Clofazimine should be taken with a meal to maximize absorption of the drug. The usual adult dosage of clofazimine for the treatment of leprosy is 50-100 mg once daily. Clofazimine also is given in a dosage regimen that includes 50 mg once daily plus an additional 300-mg dose given once monthly.
Lamprene (Clofazimine) uses
Clofazimine is used in rifampin-based multiple-drug regimens for the treatment of multibacillary and paucibacillary leprosy. The drug also has been used in the treatment and prevention of erythema nodosum leprosum (ENL) reactions (lepra type 2 reactions) in leprosy patients.
Rifapentine
Rifapentine has an antibacterial spectrum of activity similar to that of rifampin; however, on a molar basis, rifapentine and its active 25-desacetyl metabolite generally are more active than rifampin against Mycobacterium tuberculosis and more active than rifampin but less active than rifabutin against M. avium complex (MAC). The clinical relevance of activity of rifapentine against other mycobacterial species has not been established.