Management of HIV-1 Infection in Adults (Pharmacology Notes)
Despite significant changes made over the past few years in the management of human immunodeficiency virus (HIV), infection with HIV remains a leading cause of death throughout many regions of the world. According to the Joint United Nations Programme on HIV/AIDS 2008 report on the global AIDS epidemic, 30.8 million adults and 2 million children were living with HIV at the end of 2007 (1). In 2007, 2.7 million people became infected and 2 million people died of HIV (1). In the United States, approximately 1,185,000 people are HIV infected, and 24% to 27% of patients are unaware that they are HIV-positive. Furthermore, the Centers for Disease Control and Prevention estimated that approximately 56,300 people were newly infected with HIV in 2006 (2, 3). The development of antiretroviral therapy has dramatically altered the progression of disease caused by HIV and significantly improved the quality of life for many HIV-infected patients. Currently, 30 antiretroviral drugs are approved by the Food and Drug Administration (FDA) and available in the United States. These agents are approved for use in various combinations to prevent the emergence of resistant virus. The primary goals of antiretroviral therapy are to restore and preserve immunologic function, to reduce HIV-related morbidity, to prolong survival, and to improve quality of life. In order to optimize therapeutic outcomes and improve the patient’s quality of life, a thorough understanding of the pharmacological and pharmacokinetic properties of HIV medications is essential for clinicians managing HIV-infected patients. In November 2008, the Department of Health and Human Services published its updated guidelines to provide the most current recommendations for the use of antiretroviral therapy in patients with HIV infection (4, 5).