Antibiotic, Antifungal, Antiviral Drugs

The optimal time to initiate antiretroviral therapy in asymptomatic patients is unclear. A decision to initiate antiretroviral therapy in an HIV-infected adult or adolescent who is asymptomatic should be made after considering the patient’s willingness to begin antiretroviral therapy.

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.

Lactic acidosis and severe hepatomegaly with steatosis, including fatalities, have been reported in patients receiving NRTIs (abacavir, didanosine, emtricitabine, lamivudine, stavudine, zalcitabine, zidovudine).

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.

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.

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.

The most frequently reported adverse effects with amantadine are similar to those observed with rimantadine and include adverse CNS and GI effects; however, amantadine is associated with more frequent and/or severe nervous system effects than rimantadine, including in geriatric adults. Adverse effects associated with amantadine usually are mild and are reversible upon discontinuance of the drug.

Amantadine hydrochloride is administered orally as a single daily dose or, preferably, in 2 equally divided doses to minimize transitory adverse effects. It has been suggested that if insomnia occurs, the last daily dose should be taken several hours before retiring.

Amantadine hydrochloride is used for symptomatic treatment and for prophylaxis of signs and symptoms of infection caused by various human and animal or avian strains of influenza A virus. While chemoprophylaxis with the drug should not be considered a substitute for annual vaccination with influenza virus vaccine, antiviral agents are critical adjuncts to influenza vaccine for the control and prevention of influenza.