In general, the goal of treatment is to prevent the immune system from deteriorating to the point that opportunistic infections become more likely. Immune reconstitution syndrome is also less likely in patients whose immune systems are weakened to this point.
Highly active antiretroviral therapy (HAART) is the principal method for preventing immune deterioration. In addition, prophylaxis for specific opportunistic infections is indicated in particular cases.
Successful long-term HAART results in a gradual recovery of CD4 T-cell numbers and an improvement of immune responses and T-cell repertoire (previously lost antigen responses may be restored).
The peripheral T-cell counts initially surge after therapy is initiated, but this represents redistribution of activated T cells from the viral replication centers in the lymph nodes rather than a true increase in total-body CD4 T-cell counts.
In addition to virologic response and reduced risk of opportunistic infection, there is evidence to suggest that non-AIDS-defining illnesses, in particular psychiatric and renal disease, may also be reduced when on HAART.
Although multifactorial in nature (transmission mode and patient educational level are independent risk factors for these events) there may also be a direct role of HIV in these events, or an indirect role mediated through the subsequent immune dysfunction.
Some non-AIDS-defining illnesses, such as liver and cardiovascular disease, are not improved by HAART. [102]
Treatment guidelines for HIV infection are age-specific. Guidelines for pediatric populations are compiled by the Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children; guidelines for adults and adolescents are compiled by the Panel on Clinical Practices for Treatment of HIV Infection. Complete treatment guidelines may be viewed at the National Institutes of Health Web site.
For discussion of antiretroviral drugs and regimens, see Antiretroviral Therapy for HIV Infection.
Primary care interventions
The Infectious Diseases Society of America (IDSA) issued updated guidelines in November 2013 for the management of HIV infection.
Because of advances in management, HIV-infected patients are now having fewer complications and surviving longer; as a result, they are increasingly experiencing common health problems seen in the general population, and these problems must be addressed.
Accordingly, the updated IDSA guidelines emphasize the role of primary care interventions, as follows:
HIV-infected individuals should undergo screening for diabetes, osteoporosis, and colon cancer as appropriate and should be vaccinated against pneumococcal infection, influenza, varicella, and hepatitis A and B Lipid monitoring and management of lipids and other cardiovascular risk factors should be performed
Patients with well-controlled infection should undergo blood monitoring for viral levels every 6-12 months
Women with HIV should undergo annual trichomoniasis screening, and all infected patients who may be at risk should undergo annual screening for gonorrhea and chlamydia
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