Document 0722
 DOCN  M94A0722
 TI    Management of HIV disease.
 DT    9412
 AU    Volberding P; San Francisco General Hospital.
 SO    Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:18 (abstract no.
       TPI-1). Unique Identifier : AIDSLINE ASHM5/94348933
 AB    Appropriate clinical care of the HIV-infected patient includes
       consideration of antiretroviral therapy, opportunistic infection,
       management, and the treatment of HIV-associated malignancies. In
       addition, the system of care must address the numerous psychosocial
       issues posed by progressive fatal disease, typically occurring in a
       young individual. Antiretroviral therapy improves functional state and
       delays progression in patients with symptomatic HIV disease and may
       transiently delay disease progression when prescribed in asymptomatic
       HIV infection. The most appropriate time to initiate antiretroviral
       therapy is uncertain, although evidence continues to support its use in
       asymptomatic disease. Zidovudine remains the initial drug of choice as a
       monotherapy but studies continue to explore initial combination therapy.
       Zidovudine appears to remain effective for a variable length of
       time--longer in asymptomatic patients with higher CD4 cell numbers and
       shorter in patients with symptomatic disease. Following initial
       zidovudine therapy, the option of adding a second nucleoside, such as
       didanosine or zalcitabine, must be considered for those still tolerating
       zidovudine while intolerant individuals changing to one of these
       nucleosides appears to prolong the period of antiretroviral benefit.
       Recent studies indicate that combination nucleoside therapy may not be
       effective if used in patients with more advanced disease with lower CD4
       cell counts. The appropriate management of opportunistic diseases in HIV
       requires attention to prompt diagnostic approaches and the appropriate
       application of aggressive treatment. Prophylaxis, either secondary or
       primary, is employed typically for Pneumocystis, toxoplasmosis, and
       herpes simplex infection and increasingly for mycobacterium avium and
       fungal infections as well. HIV-related malignancies cannot be
       prophylaxed at this time. The quality and duration of that person's life
       can be prolonged with appropriate management of HIV-related
       malignancies, however, and this element of care must be coordinated with
       other components in a comprehensive system of medical management.
 DE    Antiviral Agents/*THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/*DRUG THERAPY/PSYCHOLOGY  Combined Modality Therapy  Drug
       Therapy, Combination  Human  HIV Infections/*DRUG THERAPY/PSYCHOLOGY
       Neoplasms/DRUG THERAPY/PSYCHOLOGY  Quality of Life
       Zidovudine/THERAPEUTIC USE  MEETING ABSTRACT

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