HIV medicine

351 Pages·2003·1.405 MB·English

by  Hoffmann C., Kamps B.S.

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: [phone]
Fax: [phone]
[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: [phone]
[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: [phone]
FAX: [phone]
E-mail: [email protected]
6 Contributing Authors
Andrea Rubbert, M.D.
Medizinische Klinik I
Universitätsklinik Köln
Joseph-Stelzmann Str 9
50924 Köln
Germany
Tel [phone]
Fax: [phone]
Christiane Schieferstein, M.D.
Medizinische Klinik II
Uniklinikum Frankfurt
Theodor-Stern-Kai 7
60590 Frankfurt am Main
Germany
Tel: [phone]
[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: [phone]
Fax: [phone]
[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: [phone]
Fax: [phone]
[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.