NEW APPROACHES TO USING ANTIRETROVIRAL THERAPY FOR THE MANAGEMENT OF HIV-INFECTION

OBJECTIVE: To review the changes that have occurred in the past 2 year s in the management of HIV infection with antiretroviral agents by con trasting the 1994 with the 1996 Guidelines. DATA SOURCES: Conference p roceedings, clinical experience of thr author and her colleagues, and English-language articles from the body of scientific literature ident ified via MEDLINE, AIDSLINE, and Current Contents served as data sourc es. DATA SYNTHESIS: Current antiretroviral management strategies inclu de movement away from using zidovudine monotherapy, institution of com bination antiretroviral therapy earlier in HIV disease, the use of new er agents such as lamivudine, protease inhibitors (i.e., saquinavir, r itonavir, indinavir), and nonnucleoside reverse transcriptase inhibito rs (i.e., nevirapine, delavirdine), prevention of vertical transmissio n with zidovudine, and use of HIV-1 RNA determinations (viral load) to guide the initiation and alteration of antiretroviral therapy. These strategies represent a dramatic change from the 1994 Guideline, which recommended zidovudine monotherapy in nonpregnant and pregnant individ uals whose CD4 cell counts were less than 500 cells/mm(3), when many o f the newer agents were not available and the assays to determine vira l load were strictly investigational. CONCLUSIONS: The difference betw een the 1994 and 1996 Guidelines is substantial. It is likely that wit hin a year's time, newer information on pathogenesis and antiretrovira l agents in development will be known and further management strategie s will need to be disseminated. Until then, the International AIDS Soc iety - USA Guidelines for 1996 should be followed as the standard of c are.