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Drug resistance testing is recommended for patients who are experiencing treatment failure (persistent or rising viral load despite adherence to an efficacious regimen) Although the ideal combination of drugs has not yet been defined for all possible clinical situations, possible choices can be better understood after a review of the available agents These drugs can be grouped into four major categories: nucleoside and nucleotide reverse transcriptase inhibitors (NRTI), protease inhibitors (PI), nonnucleoside reverse transcriptase inhibitors (NNRTI), and entry inhibitors In addition, other new classes of agents are becoming more widely available, for example, the integrase inhibitors Once antiretroviral therapy has been initiated in a patient, it is not advisable to stop the therapy unless there is a compelling reason (eg, toxicity, poor adherence, etc) So called drug holidays or structured treatment interruptions have been shown to increase risk of AIDS-related complications, increase CD4 declines, and increase morbidity from non AIDS-related complications (eg, myocardial infarctions and liver failure) 1 Nucleoside and nucleotide reverse transcriptase inhibitors a Zidovudine Zidovudine (azidothymidine; AZT) was the first approved antiviral drug for HIV infection and remains an important agent It is administered at a dose of 300 mg orally twice daily A combination of zidovudine 300 mg and lamivudine 150 mg (Combivir) allows more convenient dosing of medication for individuals taking both of these agents Side effects seen with zidovudine are listed in Table 31 5 Approximately 40% of patients experience subjective side effects that usually remit within 6 weeks The common dose-limiting side effects are anemia and neutropenia In monitoring patients receiving zidovudine, complete blood counts with platelet and differential counts should be done monthly for the first 2 months of therapy and then every 3 months b Didanosine The most convenient formulation of didanosine (ddI) is the enteric-coated capsule For adults weighing at least 60 kg, the dose is one 400-mg enteric-coated capsule orally daily; for those 30 59 kg, the dose is one 250mg enteric-coated capsule orally daily Didanosine should be taken on an empty stomach Didanosine levels are increased when it is administered with tenofovir, potentially resulting in increased side effects Therefore, this combination should be used very cautiously Didanosine does not cause anemia but may cause neutropenia It has also been associated with pancreatitis The incidence of pancreatitis with didanosine is 5 10% of fatal pancreatitis, less than 04% Patients with a history of pancreatitis, as well as those taking other medications associated with pancreatitis (including trimethoprim-sulfamethoxazole and intravenous pentamidine) are at higher risk for this complication Patients should be warned to use alcohol judiciously while taking didanosine Other common side effects with didanosine include a dose-related, reversible, painful peripheral neuropathy, which occurs in about 15% of patients, and dry mouth Fulminant hepatic failure and electrolyte abnormalities, including hypokalemia, hypocalcemia, and hypomagnesemia, have been reported in patients taking didanosine.

The first part of the header is the initializer, in which you initialize a variable. The second part is the Boolean expression to test. The third part is the iterator, in which you update the value of the counter variable. These three parts correspond to the three parts of the while loop we mentioned earlier. All of this is enclosed in parentheses. A simple for loop is shown in Example 5-14.

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