HIV medicine PDF
Preview HIV medicine
Contributing Authors Marcus Altfeld – Boston Georg Behrens – Melbourne Mario Ostrowski – Toronto Andrea Rubbert – Köln Christiane Schieferstein – Frankfurt Reinhold E. Schmidt – Hannover Bruce D. Walker – Boston Eva Wolf – München HIV Medicine 2003 www.HIVMedicine.com Edited by Christian Hoffmann and Bernd Sebastian Kamps Flying Publisher 3 Editors Christian Hoffmann, M.D. University of Schleswig Holstein Infectious Diseases Outpatient Clinic Kiel Chemnitzstr. 33 24116 Kiel, Germany Fax: + 49 431 1697 1273 www.HIVMedicine.com www.SARSReference.com Bernd Sebastian Kamps, M.D. Flying Publisher Rue Saulnier 75009 Paris France www.FlyingPublisher.com HIV Medicine is an ever-changing field. The editors and authors of HIV Medicine 2003 have made every effort to provide information that is accurate and complete as of the date of publication. However, in view of the rapid changes occurring in medical science, HIV prevention and policy, as well as the possibility of human error, this site may contain technical inaccuracies, typographical or other errors. Readers are advised to check the product information currently provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician who relies on experience and knowledge about the patient to determine dosages and the best treatment for the patient. The information contained herein is provided "as is" and without warranty of any kind. The contributors to this site, including Flying Publisher and AmedeoGroup, disclaim responsibility for any errors or omissions or for results obtained from the use of information contained herein. © 2003 by Flying Publisher – Paris, Cagliari, Wuppertal, Sevilla Assistant Editors: Nyasha Bakare, Dianne Lydtin Design: Attilio Baghino, www.a4w.it ISBN: 3-924774-37-4 4 Preface Hardly any field of medicine has ever undergone a similar stormy development to that of the therapy of HIV infection. Little more than 10 years passed, between the discovery of the pathogen and the first effective treatment! However, there is also hardly a field that is subjected to so many fast- and short- lived trends. What today seems to be statute, is tomorrow often already surpassed. Nevertheless, therapeutical freedom must not be confused with freedom of choice. This book presents the medical knowledge that is actual today: from December 2002 to January 2003. Because HIV medicine changes so fast, HIV Medicine 2003 will be updated every year. Additional chapters about opportunistic infections, malignancies and hepatitis are freely available at our Web site www.HIVMedicine.com. Under certain conditions, the editors and the authors of this book might agree to remove the copyright on HIV Medicine for all languages except English and German. You could therefore translate the content of HIV Medicine 2003 into any language and publish it under your own name – without paying a license fee. For more details, please see http://hivmedicine.com/textbook/cr.htm. Christian Hoffmann and Bernd Sebastian Kamps Hamburg/Kiel and Paris/Cagliari, January 2003 5 Contributing Authors Marcus Altfeld, M.D. Partners AIDS Research Center Massachusetts General Hospital Bldg. 149, 13th Street, 5th floor Charlestown, MA 02129 USA Tel: 617-724-2461 Fax: 617-726-5411 [email protected] Georg Behrens, M.D. Immunolgy Division Walter And Eliza Hall Institute of Medical Research PO Royal Melbourne Hospital Parkville, 3050, Victoria Australia Fax: 61-3-9347-0852 [email protected] Mario Ostrowski, M.D. Clinical Sciences Division University of Toronto Medical Sciences Building, Rm 6271 1 King's College Circle Toronto, ON M5S 1A8 Canada Tel: 416-946-5805 FAX: 416-978-8765 E-mail: [email protected] 6 Contributing Authors Andrea Rubbert, M.D. Medizinische Klinik I Universitätsklinik Köln Joseph-Stelzmann Str 9 50924 Köln Germany Tel +49 221-478-5623 Fax: +49 221-478-6459 Christiane Schieferstein, M.D. Medizinische Klinik II Uniklinikum Frankfurt Theodor-Stern-Kai 7 60590 Frankfurt am Main Germany Tel: +49 69-6301-0 [email protected] Reinhold E. Schmidt, M.D., Ph.D. Abteilung Klinische Immunologie Zentrum Innere Medizin der Medizinischen Hochschule Hannover Carl-Neuberg-Straße 1 30625 Hannover Germany Tel: +49 511-532-6656 Fax: +49 511-532-9067 [email protected] Contributing Authors 7 Bruce D. Walker, M.D., Ph.D. Partners AIDS Research Center Massachusetts General Hospital Bldg. 149, 13th Street, 5th floor Charlestown, MA 02129 USA Tel: 001 617-724-8332 Fax: 001 617-726-4691 [email protected] Eva Wolf, Dipl. Phys. Univ., M.P.H. MUC Research GmbH Karlsplatz 8 80335 München Germany Tel: +49 89 - 558 70 30 Fax: +49 89 - 550 39 41 Contents 11 Contents Chapter 1: Pathogenesis of HIV-1 Infection 15 Introduction 15 The Structure of HIV-1 17 The HIV Replication Cycle 21 HIV and the Immune System 31 References 41 Chapter 2: Acute HIV-1 Infection 47 Introduction 47 Signs and Symptoms 47 Diagnosis 48 Treatment 50 References 51 Chapter 3: HIV Therapy 2003 53 1. Perspective 53 2. Overview of Antiretroviral Drugs 61 3. Goals and Principles of Therapy 120 4. When to Start HAART 146 5. How to Start with HAART 163 6. When to Change HAART 194 7. How to Change HAART 199 8. Salvage Therapy 204 9. When to Stop HAART 215 10. Monitoring 230 Chapter 4: Management of Side Effects 247 Gastrointestinal Side Effects 248 CNS Disorders 249 Peripheral Polyneuropathy 250 Hoffmann, Kamps, et al.
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