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M94A0722.TXT
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1994-10-21
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Document 0722
DOCN M94A0722
TI Management of HIV disease.
DT 9412
AU Volberding P; San Francisco General Hospital.
SO Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:18 (abstract no.
TPI-1). Unique Identifier : AIDSLINE ASHM5/94348933
AB Appropriate clinical care of the HIV-infected patient includes
consideration of antiretroviral therapy, opportunistic infection,
management, and the treatment of HIV-associated malignancies. In
addition, the system of care must address the numerous psychosocial
issues posed by progressive fatal disease, typically occurring in a
young individual. Antiretroviral therapy improves functional state and
delays progression in patients with symptomatic HIV disease and may
transiently delay disease progression when prescribed in asymptomatic
HIV infection. The most appropriate time to initiate antiretroviral
therapy is uncertain, although evidence continues to support its use in
asymptomatic disease. Zidovudine remains the initial drug of choice as a
monotherapy but studies continue to explore initial combination therapy.
Zidovudine appears to remain effective for a variable length of
time--longer in asymptomatic patients with higher CD4 cell numbers and
shorter in patients with symptomatic disease. Following initial
zidovudine therapy, the option of adding a second nucleoside, such as
didanosine or zalcitabine, must be considered for those still tolerating
zidovudine while intolerant individuals changing to one of these
nucleosides appears to prolong the period of antiretroviral benefit.
Recent studies indicate that combination nucleoside therapy may not be
effective if used in patients with more advanced disease with lower CD4
cell counts. The appropriate management of opportunistic diseases in HIV
requires attention to prompt diagnostic approaches and the appropriate
application of aggressive treatment. Prophylaxis, either secondary or
primary, is employed typically for Pneumocystis, toxoplasmosis, and
herpes simplex infection and increasingly for mycobacterium avium and
fungal infections as well. HIV-related malignancies cannot be
prophylaxed at this time. The quality and duration of that person's life
can be prolonged with appropriate management of HIV-related
malignancies, however, and this element of care must be coordinated with
other components in a comprehensive system of medical management.
DE Antiviral Agents/*THERAPEUTIC USE AIDS-Related Opportunistic
Infections/*DRUG THERAPY/PSYCHOLOGY Combined Modality Therapy Drug
Therapy, Combination Human HIV Infections/*DRUG THERAPY/PSYCHOLOGY
Neoplasms/DRUG THERAPY/PSYCHOLOGY Quality of Life
Zidovudine/THERAPEUTIC USE MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).