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Display PDF documents in ASP . NET MVC Web applications with ...
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Symptomatic HIV disease or asymptomatic HIV disease and CD4 < 350/mcL Begin 3-drug treatment Preferred PI regimens Best first-line treatment Atripla (emtricitabine/tenofovir/ efavirenz) Truvada Lopinavir/r Combivir Lopinavir/r Epzicom Lopinavir/r
Progression of disease or viral load does not decrease by 05 log with initiation of treatment or increase of viral load by 05 log while on treatment Perform resistance testing and change to a regimen with three drugs to which the patient is not resistant, if possible Nonnucleoside reverse transcriptase inhibitors (NNRTIs) Nevirapine Delavirdine Efavirenz
The counter variable is initialized to zero in the initializer:
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Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) Zidovudine Didanosine Zalcitabine Stavudine Lamivudine Emtricitabine Abacavir Tenofovir
Protease inhibitors (Pls) Saquinavir Ritonavir Indinavir Nelfinavir Amprenavir Fosamprenavir Lopinavir/r Atazanavir Tipranavir Darunavir
Fixed-dose combinations Combivir (zidovudine/lamivudine) Truvada (emtricitabine/tenofovir) Epzicom (lamivudine/abacavir) Trizivir (zidovudine/lamivudine/abacavir) Atripla (emtricitabine/tenofovir/ efavirenz)
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the potential for antagonism that results from intracellular competition for phosphorylation Finally, the combination of didanosine with tenofovir can cause declines in CD4 counts despite excellent virologic response and appropriate dose adjustment of didanosine; the reason for this is unknown In choosing which agents to include in an initial antiretroviral regimen, ease of administration, minimization of side effects, drug resistance pattern, and future treatment options should all be considered In designing second-line regimens (sometimes called salvage regimens a term that some patients may find offensive), the goal is to identify drugs with at least some degree of antiviral activity This can be quite complicated because of the problem of cross-resistance between drugs within a class For example, the resistance patterns of lopinavir/ritonavir and indinavir are overlapping, and patients with virus resistant to these agents are unlikely to respond to nelfinavir or saquinavir even though they have never received treatment with these agents Similarly, the resistance patterns of nevirapine and efavirenz are overlapping Ideally, at least two drugs to which the patient s virus is susceptible should be added at the same time With several new classes of drugs on the horizon, the ability to provide fully suppressive regimens even to patients with extensive treatment experience and drug resistance will become more feasible The goal of therapy, therefore, should be to fully suppress viral loads to < 50 copies/mcL even for highly treatmentexperienced patients In addition to taking a careful history of what antiretroviral agents a patient has taken and for how long, genotypic and
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About Box 241 action 105, 216 217 connecting 216 217 activate 274, 277 ADC TV 302 Address Book 280 administrator 33 Advanced Research Projects Agency (ARPA) 327 Alignment panel 214 alloc 190 191 allocated memory tracking 188 allocation information capturing 149 allocation routine 135 monitoring execution 135 reporting runtime problems 135 storing diagnostic information 135 Alpha 127 ancestor file 132 ANSI C 174
phenotypic resistance testing can provide useful information in designing second-line regimens (see below) Whatever regimen is chosen, patients should be coached in ways to improve adherence For certain populations (eg, unstably housed individuals), specially tailored programs that include drug dispensing are needed For some patients, it is impossible to construct a tolerable regimen that fully suppresses HIV In such cases, clinicians and patients should consider their goals Patients maintained on effective antiretroviral agents often benefit from these regimens (eg, higher CD4 counts, fewer opportunistic infections) even if their virus is detectable In some cases, patients may request a drug holiday during which they are taken off all medications Patients often immediately feel better because of the absence of drug side effects Unfortunately, structured treatment interruptions generally result in viral rebound and CD4 decline, and patients who interrupt their treatment fare poorly compared with patients who continue their regimens without interruption 6 The challenge of drug resistance HIV-1 drug resistance limits the ability to fully control HIV replication and is a leading cause for antiretroviral regimen failure Resistance has been documented for all currently available antiretrovirals including the new class of fusion inhibitors The problem of drug resistance is widespread in HIV-infected patients undergoing treatment in countries where antiretroviral therapy is widely available A cohort study revealed that some degree of resistance developed over the first 30 months of therapy in
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