Practical Therapeutics

This chapter outlines a number of practical considerations in the construction of an antiretroviral regimen. Treatment regimens for HIV infection have evolved dramatically over the past 15 years. In 1985, treatment was limited to management of opportunistic infections, prophylactic trimethoprim-sulfamethoxazole, and zidovudine monotherapy. Clinicians now have an arsenal of 16 antiretroviral drugs to choose from along with a variety of adjunctive and supportive medications. However, increases in therapeutic options have come at the price of regimens that are increasingly complex. Food restrictions, drug interactions, scheduling, adherence, and overlapping side effects have become important factors to consider when constructing an antiretroviral regimen. Keeping abreast of this information can be overwhelming for the clinician. Moreover, antiretroviral regimens must be individualized to the patient. An understanding of the patient's lifestyle, workday, eating habits, and level of adherence is important when constructing a treatment plan. Counseling of the patient is critical to treatment success and even the simplest of regimens require a detailed explanation of food effects, potential drug interactions, adherence, and scheduling.