Treatment Goals

Management of chronic HIV infection is not unlike that of other chronic illness such as diabetes, cardiovascular disease and viral hepatitis.1

People living with HIV (PLHIV) should take an active role in their health management and therefore require an understanding of their infection, and its management.1

Team plan

Healthcare professionals (HCPs) play a vital role in facilitating the individual’s understanding of HIV and its various aspects and empowering self-management skills.1

Ideally, a management plan is negotiated that includes mutual goals for therapeutic intervention within an agreed timeframe, including1:

  • Ongoing viral suppression,
  • Maintenance of immune function,
  • Lifelong good health, and
  • Prevention of onward transmission of HIV infection

The development of a long-term management plan should be facilitated with ongoing assessments and durable record keeping and consider the patient’s other health needs and comorbidities.1

Goals of antiretroviral therapy

The key goals of antiretroviral therapy (ART) are:

  • Suppression of HIV replication to below the detection limits of 1,2 clinical assays (<20 copies/mL) function2
  • Restore and preserve immunologic survival2
  • Reduce HIV-associated morbidity and prolong transmission2
  • Prevent HIV transmission2

Maximal and durable viral suppression:

  • Preserves CD4 T-cell numbers2,3
  • Delays of prevents viral resistance2,4
  • Decreases inflammation and immune activation, which may contribute to cardiovascular and other end-organ damage observed in PLHIV2,5
  • Reduces transmission of HIV2

Discussing ART regimens with your patient

The most appropriate ART regimen is one based upon assessment of the ease of adherence, tolerability and efficacy, according to current guidelines.1,2

 

The wishes, context, lifestyle, comorbidities and other medication of PLHIV should influence the choice of ART regimen.1,2

 

Information obtained by performing the following assessments with your patient will guide ongoing management and treatment decisions:

General assessment1

This incorporates a medical and social history, which includes:

  • family history,
  • relationship status, and partner’s risk of acquiring HIV (where applicable),
  • drug and alcohol history,
  • smoking history, and
  • sexual history

Genotypic resistance assays to assess viral strains and select treatment strategies are also included.

Comorbidities1

Consider the individual’s overall health, including:

  • weight,
  • oral and dental,
  • skin,
  • pelvic
  • general systems
  • bone,
  • kidney,
  • metabolic,
  • cardiovascular,
  • liver, and
  • signs and/or symptoms of neurocognitive impairment.

Concomitant medications and the potential for drug-drug interactions should be regularly assessed.

Mental health status1

The presence of mental health issues may negatively impact adherence to ART, poor diet/reduced exercise, social withdrawal, and increased risk taking.

Therefore, psychosocial and mental health assessments at the initial consult are essential and focus on the impact of the diagnosis and coping skills, pre-morbid psychosocial issues, and specific effects relating to stigmatisation and discrimination.

Regimen side effects2

Consider how side effects with ART regimens could impact on lifestyle and any tolerability or toxicity issues experienced with previous regimens in the short and long term.

Education2

It is essential that PLHIV have a thorough understanding of the importance of adherence to prevent the development of drug resistance. Counselling interventions, community resources, family and peer advocates can be utilised to provide education about HIV risk behaviours and to support adherence.

Reproductive health2

In women, it is important that ART selection considers reproductive intent, contraceptive use and hormone replacement therapy.

Reproductive and sexual health counselling should be offered to all PLHIV who are of childbearing potential.

Treatment Guidelines

A summary of ART guidelines from the United States Department of Health and Human Services (DHHS).

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Regimen Selection

Key considerations that can influence selection of a regimen.

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