Key Treatment

Patients with a history of Ol's and a CD4+ count less than 200 are likely to benefit most from HAART, but current recommendations suggest that HAART be initiated in those with count of 350 to 500 or even higher.

Current standards of care recommend using three medications (active agents), combining an NNRTI, a PI, or an INSTI with two NRTIs. Most antiret-rovirals occasionally are preferred agents in different settings.

Darunavir or atazanavir boosted with ritonavir are the only two PIs preferred. The preferred NNRTI remains efavirenz. Efavirenz now comes coformulated with emtricitabine (a preferred NRTI) and tenofovir in a once-daily pill (Atripla). Adherence to the regimen becomes the most important factor once a regimen is selected.

Adequate response is expected at 16 to 24 months. Success is defined as suppression of viral load to 48 copies/mL. Postexposure prophylaxis involves administration of two NRTIs with or without a PI.

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