topics / مواضيع

 GOAL 4: PREVENT HUMAN IMMUNODEFICIENCY VIRUS–RELATED MORBIDITY AND MORTALITY By successfully treating HIV (suppressing viral load and restoring immune function), patients are at decreased risk for acquiring HIV-associated opportunistic infections. By achieving goals 1 through 3, goal 4 naturally follows, and truly this is the ultimate goal of the pharmacotherapy of HIV infection. With modern-day HAART therapy, patients infected with HIV are dying more frequently from non–HIV-related conditions common in the general population (i.e., cardiovascular disease, hepatic disease, non–HIV-associated malignancies). 100 Although this represents a significant achievement in care, it also provides increased complexity in caring for those who are both at risk for HIV-related illness and also receiving treatment for comorbid conditions. This increases the potential for drug–drug and drug–disease interactions. The selection of a patient-specific regimen can be a complex decision. Many potential comb

, 57 The sensitivity for these fourth-generation combination assays is >99.7%, and test results can be available within 3 hours which represents opportunity for more rapid engagement in clinical care upon a positive test result. 55 Unless there is reason to suspect very early infection, no further testing is required for a nonreactive antigen/antibody combination assay. Specimen with reactive antigen/antibody results should be further tested with an immunoassay to differentiate HIV-1 and HIV-2 antibodies. NATs for HIV RNA should be used to confirm an indeterminate antibody differentiation immunoassay or a negative antigen/antibody tests in patients where there is reason to suspect very early infection. 55 SURROGATE MARKER DATA While current guidelines recommend initiating therapeutic interventions for all HIVinfected persons ready to begin treatment, 3 the severity of immune damage and potential for disease progression should still be assessed to determine the clinical urgency for b