Antiviral therapy

• Nucleoside class of viral reverse transcriptase (RT) inhibitors have been widely used both as single agents and in combination: zidovudine (AZT), didanosine (ddl), zalcitabine (ddC), stavudine (d4T), lamuvidine (3TC) and abacavir.

• Specific therapy is followed within hours by rapid clearance of virions from the circulation and subsequently by reappearance of circulating

418 T cells and a rising count over several days. Viral resistance develops with time, especially to single agent treatment.

• Non-nucleoside class of reverse transcriptase inhibitors used in combination therapy: nevirapine and efavirenz.

• Protease inhibitors interfere with virus assembly and have dramatic effects on viral load: saquinavir, ritonavir, indinavir, amprenavir, nelfi-navir.

• The most effective antiretroviral therapy uses a combination of two nucleoside RT inhibitors plus either a non-nucleoside RT inhibitor or one or two protease inhibitors .and is currently recommended for all patients with stage 3 and 4 disease.

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