HIV and AIDS (Nursing)

Review questions:
Take Free Questions on this Article

Learning Outcome

  • Describe the clinical presentation, laboratory findings, and management of HIV/AIDS.
  • Identify the role of nurse-led care teams in the management of patients with HIV/AIDS.
  • Outline the importance of enhancing care coordination among members of an interprofessional healthcare team to ensure proper evaluation and management of HIV/AIDS disease.

Introduction

The human immunodeficiency virus (HIV) is an enveloped retrovirus that contains two copies of a single-stranded RNA genome. Without treatment, all patients with an HIV infection develop severe immunosuppression, which causes multiple opportunistic infections and HIV-associated malignancies. The last stage of an HIV infection is called acquired immunodeficiency syndrome (AIDS), which is invariably fatal.

Some patients may complain of nonspecific symptoms at the time of primary/acute HIV infection.[1] Most patients do not seek medical attention for these symptoms and remain undiagnosed. They subsequently enter a long chronic asymptomatic phase of infection, which can last for decades.[2] The end stage of the disease is defined by severe invasive opportunistic infections or HIV-associated malignancies that are termed AIDS-defining lesions.[3][4]

The World Health Organization (WHO) recommends the implementation of nurse-led teams to expand diagnostic testing and clinical care. They emphasize that nurse-led teams can effectively initiate antiretroviral therapy, manage uncomplicated opportunistic infections, and provide primary mental health/neurological care. Nurse-led home-based care has been shown to improve adherence to antiretroviral therapy (ART).[5] Consequently, increasing nurse awareness regarding the clinical presentation of various HIV stages, recommended initial therapy, and potential complications of the disease can greatly improve global outcomes for this highly prevalent and incurable disease.

Nursing Diagnosis

  • Anxiety and fear related to diagnosis
  • Deficient knowledge about the disease
  • Risk for infection due to decreased immune function
  • Ineffective therapeutic regimen management
  • Imbalanced nutrition
  • Diarrhea
  • Activity intolerance
  • Social isolation and situational low self-esteem

Causes

The human immunodeficiency virus (HIV) belongs to the Retroviridae family in the Lentivirus genus. It was first isolated and identified in 1983.[6] The HIV virus consists of 2 main types: HIV type 1 (HIV-1) and HIV type 2 (HIV-2). It contains a nucleoprotein core surrounded by a lipid membrane. The core holds two copies of viral genomic RNA along with nucleocapsid (NC), integrase (IN), and reverse transcriptase (RT) proteins. The viral core is encased in a capsid protein, which has a lattice organization that gives it the characteristic conical shape.[7]

Risk Factors

HIV is transmitted via a variety of body fluids, such as blood, breast milk, semen, and vaginal secretions. It can also be transmitted during pregnancy and delivery. Certain situations and practices increase the risk of this transmission and, therefore, warrant specific attention to minimize the spread of HIV. The WHO Consolidated Guidelines for HIV identify five key populations that are disproportionately affected by HIV. They include men who have sex with men (MSM), sex workers, people in prisons and other closed settings, people who inject drugs, and trans and gender-diverse people.[8] 

The vast majority of HIV infections worldwide occur due to sexual contact. An estimated 80% of HIV infections in the world occur due to heterosexual transmission.[9] However, in the United States, this statistic does not hold true. According to the United States Centers for Disease Control and Prevention (CDC) HIV factsheet, male-to-male sexual contact accounted for 70% of all new HIV diagnoses in the United States, while heterosexual contact accounted for only 22% of all new HIV diagnoses in 2021.

Intravenous drug use is another major risk factor for HIV infection. According to a meta-analysis from 2008 estimated that approximately 3.0 million people who inject drugs might be HIV positive worldwide.[10] According to the CDC HIV Factsheet, 1 in 10 new HIV infections in the United States can be attributed to intravenous drug use either alone or in MSM who report intravenous drug use. A systematic review evaluating the effectiveness of needle and syringe exchange programs reported that adequate needle and syringe exchange programs were effective in reducing risky injection behaviors (sharing and reusing needles) and in reducing HIV transmission among persons with intravenous drug use (PWID).[11]

Assessment

Acute HIV infection (or primary HIV infection) is characterized by the following symptoms:

  • Fever
  • Joint pain
  • Skin rash
  • Sore throat
  • Swollen lymph nodes[1]

Chronic HIV infection is usually asymptomatic. It may be characterized by nonspecific signs and symptoms such as:

  • Fever
  • Fatigue
  • Diarrhea
  • Weight loss
  • Oral thrush
  • Shingles
  • Persistent generalized lymphadenopathy[2]

Eventually, untreated HIV progresses to advanced disease, which manifests itself with a myriad of opportunistic infections and conditions. Acquired immune deficiency syndrome (AIDS) can be diagnosed when specific AIDS-defining conditions are noted, regardless of the CD4+ lymphocyte cell count. These AIDS-defining conditions, as outlined by the CDC, include:[12]

  • Candidiasis of the digestive tract (other than thrush)
  • Candidiasis of the pulmonary tract
  • Invasive cervical cancer
  • Extrapulmonary or disseminated coccidioidomycosis, histoplasmosis, or cryptococcosis
  • Chronic intestinal cryptosporidiosis or isosporiasis
  • Cytomegalovirus retinitis
  • Kaposi sarcoma
  • HIV encephalitis
  • Primary lymphoma of the brain
  • Burkitt lymphoma
  • Mycobacterial infections
  • Pneumocystis jirovecii pneumonia
  • Progressive multifocal leukoencephalopathy

Clinical Staging

The World Health Organization (WHO) has provided a clinical assessment and staging guide for healthcare professionals, which becomes particularly useful in resource-limited areas. The revised WHO clinical staging ladder of HIV and AIDS (for adolescents and adults 15 years of age or older) as published in the "Interim WHO Clinical Staging of HIV/AIDS and HIV/AIDS Case Definitions for Surveillance - Africa Region," in 2005 defines the following clinical stages for HIV infection:

  • Primary HIV infection
    • Consists of patients who are asymptomatic or those with symptoms of acute retroviral syndrome.
  • Stage 1
    • Consists of patients who are asymptomatic and/or those with persistent generalized lymphadenopathy, which is defined as enlarged lymph nodes (more than 1 cm) in two or more non-contiguous sites (excluding inguinal nodes) that are not better explained by any other cause.
  • Stage 2
    • Consists of patients who experience unexplained weight loss (moderate degree, less than 10% of body weight), recurrent respiratory tract infections, herpes zoster exacerbations (mild to moderate severity), angular cheilitis, recurrent oral ulcerations, papular pruritic eruptions, seborrhoeic dermatitis, or fungal nail infections of fingers.
  • Stage 3
    • Consists of patients who develop severe weight loss (more than 10% of body weight), unexplained chronic diarrhea, persistent fever, oral candidiasis, oral hairy leukoplakia, pulmonary tuberculosis, severe invasive bacterial infections (such as pneumonia, empyema, osteomyelitis, meningitis, and bacteremia), acute necrotizing ulcerative stomatitis, gingivitis or periodontitis, and unexplained anemia, neutropenia, and/or thrombocytopenia for more than one month.
  • Stage 4
    • Consists of patients who develop HIV wasting syndrome, pneumocystis pneumonia, chronic herpes simplex infection, esophageal candidiasis, extrapulmonary tuberculosis, Kaposi sarcoma, toxoplasmosis, HIV encephalopathy, extrapulmonary cryptococcosis infections, disseminated non-tuberculous mycobacterial infections, progressive multifocal leukoencephalopathy, pulmonary candidiasis, cryptosporidiosis, isosporiasis, cytomegalovirus (CMV) retinitis (or in an organ other than liver, spleen or lymph nodes), disseminated mycoses (such as histoplasmosis, coccidiomycosis, penicilliosis), recurrent salmonella septicemia, lymphoma (cerebral or B cell non-Hodgkin), invasive cervical carcinoma, or visceral leishmaniasis.

The WHO defines HIV wasting syndrome as the presence of unexplained weight loss that is greater than 10% of the body weight, with the presence of either unexplained chronic diarrhea or the presence of unexplained fever for one month or more. Stage 4 of the WHO clinical staging ladder corresponds to AIDS, with the clinical criteria being almost identical to that outlined by the CDC.

A thorough medical history and review of the system are indicated for patients who are suspected to have an HIV infection or those who have been diagnosed with it. Ideally, this should be conducted at the very first encounter at the time of the initial diagnosis. A comprehensive history and physical examination are necessary to help identify opportunistic infections and other HIV-associated conditions. This not only helps with the clinical staging of this infection but will also identify concurrent conditions that must be addressed.[13]

Sexual history is required in the evaluation of patients with HIV. It is critical to obtain the sexual history in a nonjudgmental manner. The sexual history should elucidate information regarding the number of partners, sexual practices, frequency of contraceptive use, and previous history of sexually transmitted infections (STIs). The HIV status of current and past partners should be obtained.[13]

Evaluation

There are several tests to diagnose HIV infections:[14][15]

  • Fourth-generation immunoassays: Detect HIV-specific antibodies and p24 HIV antigens
  • Rapid tests: Use blood or saliva to detect an HIV infection within hours. Rapid tests cannot be used to make the diagnosis of HIV. Positive rapid test results must be verified using immunoassays described above.[16]
  • Polymerase-chain-reactions (RT-PCR): Can be a diagnostic or a confirmative test for HIV infection and can provide information about the viral load.

When there is a possibility of acute or early HIV infection, the most sensitive screening immunoassay available should be used (ideally, a combination antigen/antibody immunoassay). In addition, an HIV virologic (viral load) test should be performed. RT-PCR-based viral load test is favored in patients with recent known exposure to diagnose acute HIV infections. A positive HIV virologic test generally indicates HIV infection.

It is important to note that detectable viremia does not develop until approximately 10 to 15 days after infection, and even the most sensitive immunoassays do not give a positive result until 5 days after that. Therefore, initial negative immunoassay and virologic test results can be misleading, and if the clinical suspicion for recent HIV exposure is high, repeat testing is done 1 to 2 weeks later.

The diagnosis of AIDS is made based on the presence of AIDS-defining lesions outlined above.

Once the diagnosis of HIV is established, further testing should include a quantitative CD4+ lymphocyte (CD4) count, quantitative plasma HIV RNA or "viral load," and HIV drug-resistance assessment.[16] Normal CD4 count is greater than or equal to 500 cells/mm3. A CD4 count of less than 200 cells/mm3 defines severe immunosuppression and warrants prophylactic treatment for certain opportunistic infections.[17]

Medical Management

Patients with HIV/AIDS require lifelong combination antiretroviral therapy to suppress viral load in the blood and improve immune functions. Antiretroviral therapy (ART) should be provided to all persons with HIV, regardless of their immune status (CD4 count) or symptoms. 

Multiple different classes of drugs are available for the treatment of HIV. Antiretroviral drug classes commonly used in treatment-naive patients include:

  • Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Protease inhibitors (PIs)
  • Integrase strand transfer inhibitors (INSTIs)

Other drug classes, such as CCR5 antagonists, fusion inhibitors, attachment inhibitors, capsid inhibitors, and post-attachment inhibitors, are reserved for patients with multidrug-resistant HIV infections.

Current guidelines recommend INSTI-based therapy with dual NRTI-backbone for most persons with HIV. INSTI-based regimens have been shown to achieve faster viral suppression than PI- or NNRTI-containing regimens.[17] Alternative regimens may be required due to underlying comorbidities (such as renal failure) and the results of the viral load and HIV resistance profile.

In patients with a serious opportunistic infection, rapid initiation of ART can be clinically detrimental. In such cases, treatment of the opportunistic infection should be initiated prior to ART to decrease the risk of immune reconstitution inflammatory syndrome (IRIS).[16] Current recommendations are to initiate ART within two weeks of diagnosis for most acute opportunistic infections.[18] 

The goal of therapy is to achieve sustained virologic suppression, as evidenced by an HIV RNA level that remains persistently below the lower limit of detection (undetectable). This is defined as an HIV RNA level of less than 200 copies/mL. If virologic suppression is not achieved, genotype resistance testing should be obtained.[17]

In addition to rapid initiation of ART, prophylaxis for opportunistic infections based on the level of immunosuppression must also be addressed.

  • In patients who have thrush on presentation or a CD4 count of less than 200 cells/mm3, prophylaxis for Pneumocystis jirovecii pneumonia is indicated.
  • Patients with a CD4 count of less than 100 cells/mm3 and a positive serum cryptococcal antigen require prophylaxis against cryptococcus.
  • Prophylaxis against histoplasmosis is recommended in areas where histoplasmosis is endemic and the patient has a CD4 count of less than 150 cells/mm3.
  • Prophylaxis against Mycobacterium avium complex (MAC) is no longer required in patients with HIV who are rapidly initiated on ART.[19] Patients with a CD4 count of less than 50 cells/mm3 who are not on ART should receive prophylaxis against MAC.
  • Patients with CD4 counts less than 100 cells/mm3 who are positive for toxoplasma antibodies require chemoprophylaxis against Toxoplasma gondii.[16] 

Follow-up laboratory testing is indicated within six weeks of starting ART. Virologic suppression to undetectable levels may take up to 24 weeks of continuous therapy. However, if the HIV RNA level has not declined by 2 log10 copies/mL within 12 weeks, further evaluation for resistance with genotype testing for the patient’s regimen is recommended (if adherence is confirmed).[17]

Nursing Management

Nurse interventions in the management of patients with HIV/AIDS include:

  • Provide education and counseling to inform them about HIV/AIDS and help them understand that complications can essentially be minimized with proper treatment.
  • Provide education about the risk of transmission if HIV viral load remains elevated. 
  • Emphasize "undetectable equals untransmittable" to motivate patient adherence.
  • Monitor for signs of infection and laboratory tests that indicate infection.
  • Provide education regarding the risk of resistance if medication nonadherence occurs. 
  • Ensure adequate nutrition and hydration to mitigate the effects of HIV wasting syndrome.
  • Monitor weight and educate the patient regarding lifestyle changes that can be used to mitigate weight gain associated with ART.
  • Improve activity and assist in planning daily routines that maintain activity to optimize function and balance.
  • Provide counseling to help the patient maintain social support.

When To Seek Help

  • High fever
  • Signs of dehydration or malnutrition
  • Unstable or changing vital signs
  • Concerns over failure to take medications as prescribed
  • Increasing depression
  • Change/decline in urine output

Outcome Identification

Outcome goals for a patient with HIV/AIDS include:

  • Avoid infection
  • Improve activity
  • Maintain nutritional status
  • Maintain socialization
  • Maintain homeostasis
  • Promote comfort
  • Support psychosocial adjustment
  • Maintain medication compliance

Monitoring

Monitor for signs of infection such as:

  • Fever
  • Fatigue
  • Lethargy
  • Elevated heart rate
  • Low blood pressure

Monitor for medication adherence by reviewing the following:

  • Prescription fill history
  • Laboratory tests showing CD4 count maintained above 500 cell/mm3 or an improvement in CD4 count if it was previously below this level
  • Laboratory tests showing persistently declining or undetectable HIV viral load

Monitor for side effects of medication such as:

  • Nausea/vomiting
  • Diarrhea
  • Loss of appetite
  • Insomnia
  • Weight gain

Coordination of Care

The management of an HIV-positive patient is complex, and it should be carried out by an interprofessional healthcare team that includes nurses, social workers, pharmacists, and clinical providers. If an opportunistic infection or a mass develops, the patient should be evaluated by a clinician immediately to ensure adequate treatment is given. 

Health Teaching and Health Promotion

Principal facts for patient education in patients with HIV include:

  • Inform all sexual partners that may have been exposed.
  • Use a clean needle to inject drugs and dispose of it. It is imperative that one should not share it with anybody.
  • Use a clean condom at all times when having sexual intercourse. Preferably, use a condom that contains a water-based lubricant, which is more protective.

Discharge Planning

Discharge planning includes written instructions on medication regime and adverse reactions to report. Patients who are not independent in activities of daily living may be referred to home care services for assistance with care. Physical therapy and occupational therapy can be effective in increasing strength and endurance. Patients often experience weakness and fatigue, requiring monitoring for safety.

Including family and support members to assist the patient's transition home is crucial to maintaining compliance with care. The patient should also be referred to a social worker to ensure resources in the home are adequate for care. Community resources may also be considered for assistance with financial support to ensure the patient can pay for medications. It is important to remember that the person is "Living with HIV" and that the plan of care should include resuming activities of daily living. Patient teaching during the discharge process should include methods for healthy living, prevention of complications, and avoidance of transmission.

Details

Nurse Editor

Kathleen M. Pinto

Author

Helena M. Swinkels

Author

Angel A. Justiz Vaillant

Author

Andrew D. Nguyen

Editor:

Peter G. Gulick

Updated:

7/27/2024 5:15:49 PM

Feedback:

Send Us Your Comments

References

[1]

Meissner ME, Talledge N, Mansky LM. Molecular Biology and Diversification of Human Retroviruses. Frontiers in virology (Lausanne, Switzerland). 2022:2():. pii: 872599. doi: 10.3389/fviro.2022.872599. Epub 2022 Jun 2     [PubMed PMID: 35783361]

[2]

Kahn JO, Walker BD. Acute human immunodeficiency virus type 1 infection. The New England journal of medicine. 1998 Jul 2:339(1):33-9     [PubMed PMID: 9647878]

[3]

Xu Y, Ollerton MT, Connick E. Follicular T-cell subsets in HIV infection: recent advances in pathogenesis research. Current opinion in HIV and AIDS. 2019 Mar:14(2):71-76. doi: 10.1097/COH.0000000000000525. Epub     [PubMed PMID: 30585797]

[4]

Chadburn A, Abdul-Nabi AM, Teruya BS, Lo AA. Lymphoid proliferations associated with human immunodeficiency virus infection. Archives of pathology & laboratory medicine. 2013 Mar:137(3):360-70. doi: 10.5858/arpa.2012-0095-RA. Epub     [PubMed PMID: 23451747]

[5]

Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2021 Dec 6:73(11):e3572-e3605. doi: 10.1093/cid/ciaa1391. Epub     [PubMed PMID: 33225349]

[6]

Thio CL, Seaberg EC, Skolasky R Jr, Phair J, Visscher B, Muñoz A, Thomas DL, Multicenter AIDS Cohort Study. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet (London, England). 2002 Dec 14:360(9349):1921-6     [PubMed PMID: 12493258]

[7]

Yin Z, Rice BD, Waight P, Miller E, George R, Brown AE, Smith RD, Slack M, Delpech VC. Invasive pneumococcal disease among HIV-positive individuals, 2000-2009. AIDS (London, England). 2012 Jan 2:26(1):87-94. doi: 10.1097/QAD.0b013e32834dcf27. Epub     [PubMed PMID: 22008657]

[8]

Brew BJ, Garber JY. Neurologic sequelae of primary HIV infection. Handbook of clinical neurology. 2018:152():65-74. doi: 10.1016/B978-0-444-63849-6.00006-2. Epub     [PubMed PMID: 29604985]

[9]

Robb ML, Eller LA, Kibuuka H, Rono K, Maganga L, Nitayaphan S, Kroon E, Sawe FK, Sinei S, Sriplienchan S, Jagodzinski LL, Malia J, Manak M, de Souza MS, Tovanabutra S, Sanders-Buell E, Rolland M, Dorsey-Spitz J, Eller MA, Milazzo M, Li Q, Lewandowski A, Wu H, Swann E, O'Connell RJ, Peel S, Dawson P, Kim JH, Michael NL, RV 217 Study Team. Prospective Study of Acute HIV-1 Infection in Adults in East Africa and Thailand. The New England journal of medicine. 2016 Jun 2:374(22):2120-30. doi: 10.1056/NEJMoa1508952. Epub 2016 May 18     [PubMed PMID: 27192360]

[10]

Lavreys L, Baeten JM, Chohan V, McClelland RS, Hassan WM, Richardson BA, Mandaliya K, Ndinya-Achola JO, Overbaugh J. Higher set point plasma viral load and more-severe acute HIV type 1 (HIV-1) illness predict mortality among high-risk HIV-1-infected African women. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2006 May 1:42(9):1333-9     [PubMed PMID: 16586394]

[11]

Lapins J, Gaines H, Lindbäck S, Lidbrink P, Emtestam L. Skin and mucosal characteristics of symptomatic primary HIV-1 infection. AIDS patient care and STDs. 1997 Apr:11(2):67-70     [PubMed PMID: 11361765]

[12]

Osmond D, Chaisson R, Moss A, Bacchetti P, Krampf W. Lymphadenopathy in asymptomatic patients seropositive for HIV. The New England journal of medicine. 1987 Jul 23:317(4):246     [PubMed PMID: 3474522]

[13]

Suryana K, Suharsono H, Antara IGPJ. Factors Associated with Oral Candidiasis in People Living with HIV/AIDS: A Case Control Study. HIV/AIDS (Auckland, N.Z.). 2020:12():33-39. doi: 10.2147/HIV.S236304. Epub 2020 Jan 14     [PubMed PMID: 32021484]

[14]

Apalata T, Longo-Mbenza B, Sturm A, Carr W, Moodley P. Factors Associated with Symptomatic Vulvovaginal Candidiasis: A Study among Women Attending a Primary Healthcare Clinic in Kwazulu-Natal, South Africa. Annals of medical and health sciences research. 2014 May:4(3):410-6. doi: 10.4103/2141-9248.133470. Epub     [PubMed PMID: 24971218]

[15]

Ottria L, Lauritano D, Oberti L, Candotto V, Cura F, Tagliabue A, Tettamanti L. Prevalence of HIV-related oral manifestations and their association with HAART and CD4+ T cell count: a review. Journal of biological regulators and homeostatic agents. 2018 Jan-Feb:32(2 Suppl. 1):51-59     [PubMed PMID: 29460518]

[16]

Brown P, Elmasry S, Olagunju A, Garcia S, Sarihan M. A Case of Disseminated Cutaneous Herpes Simplex Virus-1 as the First Manifestation of Human Immunodeficiency Virus Infection. Journal of investigative medicine high impact case reports. 2021 Jan-Dec:9():23247096211045245. doi: 10.1177/23247096211045245. Epub     [PubMed PMID: 34521234]

[17]

Timoney MT, Atrio JM, McGowan JP, Fine SM, Vail R, Merrick ST, Radix A, Hoffmann CJ, Gonzalez CJ. Screening for Cervical Dysplasia and Cancer in Adults With HIV. 2022 Mar:():     [PubMed PMID: 35467815]

[18]

Knight CL. Physical Examination in Human Immunodeficiency Virus Disease. The Medical clinics of North America. 2022 May:106(3):527-536. doi: 10.1016/j.mcna.2022.01.001. Epub 2022 Apr 4     [PubMed PMID: 35491072]

[19]

Centers for Disease Control and Prevention (CDC). Revised surveillance case definition for HIV infection--United States, 2014. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 2014 Apr 11:63(RR-03):1-10     [PubMed PMID: 24717910]

[20]

Damtie D, Yismaw G, Woldeyohannes D, Anagaw B. Common opportunistic infections and their CD4 cell correlates among HIV-infected patients attending at antiretroviral therapy clinic of Gondar University Hospital, Northwest Ethiopia. BMC research notes. 2013 Dec 14:6():534. doi: 10.1186/1756-0500-6-534. Epub 2013 Dec 14     [PubMed PMID: 24330921]

[21]

Kumarasamy N, Vallabhaneni S, Flanigan TP, Mayer KH, Solomon S. Clinical profile of HIV in India. The Indian journal of medical research. 2005 Apr:121(4):377-94     [PubMed PMID: 15817951]

[22]

Burudpakdee C, Near AM, Tse J, Faccone J, Rodriguez PL, Karichu JK, Cheng MM. Real-world HIV diagnostic testing patterns in the United States. The American journal of managed care. 2022 Feb 1:28(2):e42-e48. doi: 10.37765/ajmc.2022.88826. Epub 2022 Feb 1     [PubMed PMID: 35139295]

[23]

Goldschmidt R, Chu C. HIV Infection in Adults: Initial Management. American family physician. 2021 Apr 1:103(7):407-416     [PubMed PMID: 33788514]

[24]

Gandhi RT, Bedimo R, Hoy JF, Landovitz RJ, Smith DM, Eaton EF, Lehmann C, Springer SA, Sax PE, Thompson MA, Benson CA, Buchbinder SP, Del Rio C, Eron JJ Jr, Günthard HF, Molina JM, Jacobsen DM, Saag MS. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2023 Jan 3:329(1):63-84. doi: 10.1001/jama.2022.22246. Epub     [PubMed PMID: 36454551]

[25]

Lévy Y, Lelièvre JD, Assoumou L, Aznar E, Pulido F, Tambussi G, Crespo M, Meybeck A, Molina JM, Delaugerre C, Izopet J, Peytavin G, Cardon F, Diallo A, Lancar R, Béniguel L, Costagliola D. Addition of Maraviroc Versus Placebo to Standard Antiretroviral Therapy for Initial Treatment of Advanced HIV Infection: A Randomized Trial. Annals of internal medicine. 2020 Mar 3:172(5):297-305. doi: 10.7326/M19-2133. Epub 2020 Feb 11     [PubMed PMID: 32040959]

[26]

Saag MS. HIV Infection - Screening, Diagnosis, and Treatment. The New England journal of medicine. 2021 Jun 3:384(22):2131-2143. doi: 10.1056/NEJMcp1915826. Epub     [PubMed PMID: 34077645]

[27]

Jacobson K, Ogbuagu O. Integrase inhibitor-based regimens result in more rapid virologic suppression rates among treatment-naïve human immunodeficiency virus-infected patients compared to non-nucleoside and protease inhibitor-based regimens in a real-world clinical setting: A retrospective cohort study. Medicine. 2018 Oct:97(43):e13016. doi: 10.1097/MD.0000000000013016. Epub     [PubMed PMID: 30412140]

[28]

INSIGHT START Study Group, Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, Avihingsanon A, Cooper DA, Fätkenheuer G, Llibre JM, Molina JM, Munderi P, Schechter M, Wood R, Klingman KL, Collins S, Lane HC, Phillips AN, Neaton JD. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. The New England journal of medicine. 2015 Aug 27:373(9):795-807. doi: 10.1056/NEJMoa1506816. Epub 2015 Jul 20     [PubMed PMID: 26192873]

[29]

Diaz RS, Hunter JR, Camargo M, Dias D, Galinskas J, Nassar I, de Lima IB, Caldeira DB, Sucupira MC, Schechter M. Dolutegravir-associated resistance mutations after first-line treatment failure in Brazil. BMC infectious diseases. 2023 May 24:23(1):347. doi: 10.1186/s12879-023-08288-8. Epub 2023 May 24     [PubMed PMID: 37226112]

[30]

DeKoven S, Naccarato M, Brumme CJ, Tan DHS. Treatment-emergent reverse transcriptase resistance during antiretroviral therapy with bictegravir, tenofovir alafenamide, and emtricitabine: A case series. HIV medicine. 2023 Nov:24(11):1137-1143. doi: 10.1111/hiv.13520. Epub 2023 Jun 14     [PubMed PMID: 37317505]

[31]

Wensing AM, Calvez V, Ceccherini-Silberstein F, Charpentier C, Günthard HF, Paredes R, Shafer RW, Richman DD. 2022 update of the drug resistance mutations in HIV-1. Topics in antiviral medicine. 2022 Oct:30(4):559-574     [PubMed PMID: 36375130]

[32]

Margot NA, Wong P, Kulkarni R, White K, Porter D, Abram ME, Callebaut C, Miller MD. Commonly Transmitted HIV-1 Drug Resistance Mutations in Reverse-Transcriptase and Protease in Antiretroviral Treatment-Naive Patients and Response to Regimens Containing Tenofovir Disoproxil Fumarate or Tenofovir Alafenamide. The Journal of infectious diseases. 2017 Mar 15:215(6):920-927. doi: 10.1093/infdis/jix015. Epub     [PubMed PMID: 28453836]

[33]

Siedner MJ, Moosa MS, McCluskey S, Gilbert RF, Pillay S, Aturinda I, Ard K, Muyindike W, Musinguzi N, Masette G, Pillay M, Moodley P, Brijkumar J, Rautenberg T, George G, Gandhi RT, Johnson BA, Sunpath H, Bwana MB, Marconi VC. Resistance Testing for Management of HIV Virologic Failure in Sub-Saharan Africa : An Unblinded Randomized Controlled Trial. Annals of internal medicine. 2021 Dec:174(12):1683-1692. doi: 10.7326/M21-2229. Epub 2021 Oct 26     [PubMed PMID: 34698502]

[34]

Paton NI, Musaazi J, Kityo C, Walimbwa S, Hoppe A, Balyegisawa A, Asienzo J, Kaimal A, Mirembe G, Lugemwa A, Ategeka G, Borok M, Mugerwa H, Siika A, Odongpiny ELA, Castelnuovo B, Kiragga A, Kambugu A, NADIA Trial Team. Efficacy and safety of dolutegravir or darunavir in combination with lamivudine plus either zidovudine or tenofovir for second-line treatment of HIV infection (NADIA): week 96 results from a prospective, multicentre, open-label, factorial, randomised, non-inferiority trial. The lancet. HIV. 2022 Jun:9(6):e381-e393. doi: 10.1016/S2352-3018(22)00092-3. Epub 2022 Apr 20     [PubMed PMID: 35460601]

[35]

Blanco JL, Marcelin AG, Katlama C, Martinez E. Dolutegravir resistance mutations: lessons from monotherapy studies. Current opinion in infectious diseases. 2018 Jun:31(3):237-245. doi: 10.1097/QCO.0000000000000453. Epub     [PubMed PMID: 29634660]

[36]

Hanna GJ, D'Aquila RT. Clinical use of genotypic and phenotypic drug resistance testing to monitor antiretroviral chemotherapy. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2001 Mar 1:32(5):774-82     [PubMed PMID: 11229846]

[37]

Patel DM, Moyo C, Bositis CM. A Review of the 2010 WHO Adult Antiretroviral Therapy Guidelines: Implications and Realities of These Changes for Zambia. Medical journal of Zambia. 2010:37(2):118-124     [PubMed PMID: 23193354]

[38]

. Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach: 2010 Revision. 2010:():     [PubMed PMID: 23741771]

[39]

Segal-Maurer S, DeJesus E, Stellbrink HJ, Castagna A, Richmond GJ, Sinclair GI, Siripassorn K, Ruane PJ, Berhe M, Wang H, Margot NA, Dvory-Sobol H, Hyland RH, Brainard DM, Rhee MS, Baeten JM, Molina JM, CAPELLA Study Investigators. Capsid Inhibition with Lenacapavir in Multidrug-Resistant HIV-1 Infection. The New England journal of medicine. 2022 May 12:386(19):1793-1803. doi: 10.1056/NEJMoa2115542. Epub     [PubMed PMID: 35544387]

[40]

Kozal M, Aberg J, Pialoux G, Cahn P, Thompson M, Molina JM, Grinsztejn B, Diaz R, Castagna A, Kumar P, Latiff G, DeJesus E, Gummel M, Gartland M, Pierce A, Ackerman P, Llamoso C, Lataillade M, BRIGHTE Trial Team. Fostemsavir in Adults with Multidrug-Resistant HIV-1 Infection. The New England journal of medicine. 2020 Mar 26:382(13):1232-1243. doi: 10.1056/NEJMoa1902493. Epub     [PubMed PMID: 32212519]

[41]

Blair HA. Ibalizumab: A Review in Multidrug-Resistant HIV-1 Infection. Drugs. 2020 Feb:80(2):189-196. doi: 10.1007/s40265-020-01258-3. Epub     [PubMed PMID: 31970712]

[42]

Reeves I, Cromarty B, Deayton J, Dhairyawan R, Kidd M, Taylor C, Thornhill J, Tickell-Painter M, van Halsema C. British HIV Association guidelines for the management of HIV-2 2021. HIV medicine. 2021 Dec:22 Suppl 4():1-29. doi: 10.1111/hiv.13204. Epub     [PubMed PMID: 34927347]

[43]

Raugi DN, Smith RA, Ba S, Toure M, Traore F, Sall F, Pan C, Blankenship L, Montano A, Olson J, Dia Badiane NM, Mullins JI, Kiviat NB, Hawes SE, Sow PS, Gottlieb GS, University of Washington-Dakar HIV-2 Study Group. Complex patterns of protease inhibitor resistance among antiretroviral treatment-experienced HIV-2 patients from Senegal: implications for second-line therapy. Antimicrobial agents and chemotherapy. 2013 Jun:57(6):2751-60. doi: 10.1128/AAC.00405-13. Epub 2013 Apr 9     [PubMed PMID: 23571535]

[44]

Smith RA, Raugi DN, Pan C, Sow PS, Seydi M, Mullins JI, Gottlieb GS, University of Washington-Dakar HIV-2 Study Group. In vitro activity of dolutegravir against wild-type and integrase inhibitor-resistant HIV-2. Retrovirology. 2015 Feb 5:12():10. doi: 10.1186/s12977-015-0146-8. Epub 2015 Feb 5     [PubMed PMID: 25808007]

[45]

Volberding PA. HIV Treatment and Prevention: An Overview of Recommendations From the IAS-USA Antiretroviral Guidelines Panel. Topics in antiviral medicine. 2017 Feb/Mar:25(1):17-24     [PubMed PMID: 28402930]

[46]

Soriano V, Dona C, Rodríguez-Rosado R, Barreiro P, González-Lahoz J. Discontinuation of secondary prophylaxis for opportunistic infections in HIV-infected patients receiving highly active antiretroviral therapy. AIDS (London, England). 2000 Mar 10:14(4):383-6     [PubMed PMID: 10770540]

[47]

Ioannidis JP, Cappelleri JC, Skolnik PR, Lau J, Sacks HS. A meta-analysis of the relative efficacy and toxicity of Pneumocystis carinii prophylactic regimens. Archives of internal medicine. 1996 Jan 22:156(2):177-88     [PubMed PMID: 8546551]

[48]

Thera MA, Sehdev PS, Coulibaly D, Traore K, Garba MN, Cissoko Y, Kone A, Guindo A, Dicko A, Beavogui AH, Djimde AA, Lyke KE, Diallo DA, Doumbo OK, Plowe CV. Impact of trimethoprim-sulfamethoxazole prophylaxis on falciparum malaria infection and disease. The Journal of infectious diseases. 2005 Nov 15:192(10):1823-9     [PubMed PMID: 16235184]

[49]

Bozzette SA, Finkelstein DM, Spector SA, Frame P, Powderly WG, He W, Phillips L, Craven D, van der Horst C, Feinberg J. A randomized trial of three antipneumocystis agents in patients with advanced human immunodeficiency virus infection. NIAID AIDS Clinical Trials Group. The New England journal of medicine. 1995 Mar 16:332(11):693-9     [PubMed PMID: 7854375]

[50]

Stahl-Bayliss CM, Kalman CM, Laskin OL. Pentamidine-induced hypoglycemia in patients with the acquired immune deficiency syndrome. Clinical pharmacology and therapeutics. 1986 Mar:39(3):271-5     [PubMed PMID: 3485027]

[51]

Pamba A, Richardson ND, Carter N, Duparc S, Premji Z, Tiono AB, Luzzatto L. Clinical spectrum and severity of hemolytic anemia in glucose 6-phosphate dehydrogenase-deficient children receiving dapsone. Blood. 2012 Nov 15:120(20):4123-33. doi: 10.1182/blood-2012-03-416032. Epub 2012 Sep 19     [PubMed PMID: 22993389]

[52]

Hughes W, Leoung G, Kramer F, Bozzette SA, Safrin S, Frame P, Clumeck N, Masur H, Lancaster D, Chan C. Comparison of atovaquone (566C80) with trimethoprim-sulfamethoxazole to treat Pneumocystis carinii pneumonia in patients with AIDS. The New England journal of medicine. 1993 May 27:328(21):1521-7     [PubMed PMID: 8479489]

[53]

Schneider MM, Borleffs JC, Stolk RP, Jaspers CA, Hoepelman AI. Discontinuation of prophylaxis for Pneumocystis carinii pneumonia in HIV-1-infected patients treated with highly active antiretroviral therapy. Lancet (London, England). 1999 Jan 16:353(9148):201-3     [PubMed PMID: 9923876]

[54]

Ewald H, Raatz H, Boscacci R, Furrer H, Bucher HC, Briel M. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV infection. The Cochrane database of systematic reviews. 2015 Apr 2:2015(4):CD006150. doi: 10.1002/14651858.CD006150.pub2. Epub 2015 Apr 2     [PubMed PMID: 25835432]

[55]

Smego RA Jr, Nagar S, Maloba B, Popara M. A meta-analysis of salvage therapy for Pneumocystis carinii pneumonia. Archives of internal medicine. 2001 Jun 25:161(12):1529-33     [PubMed PMID: 11427101]

[56]

Derouin F, Piketty C, Chastang C, Chau F, Rouveix B, Pocidalo JJ. Anti-Toxoplasma effects of dapsone alone and combined with pyrimethamine. Antimicrobial agents and chemotherapy. 1991 Feb:35(2):252-5     [PubMed PMID: 2024957]

[57]

Miro JM, Lopez JC, Podzamczer D, Peña JM, Alberdi JC, Martínez E, Domingo P, Cosin J, Claramonte X, Arribas JR, Santín M, Ribera E, GESIDA 04/98 Study Group. Discontinuation of primary and secondary Toxoplasma gondii prophylaxis is safe in HIV-infected patients after immunological restoration with highly active antiretroviral therapy: results of an open, randomized, multicenter clinical trial. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2006 Jul 1:43(1):79-89     [PubMed PMID: 16758422]

[58]

Sheth AN, Althoff KN, Brooks JT. Influenza susceptibility, severity, and shedding in HIV-infected adults: a review of the literature. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011 Jan 15:52(2):219-27. doi: 10.1093/cid/ciq110. Epub     [PubMed PMID: 21288848]

[59]

Cohen C, Moyes J, Tempia S, Groom M, Walaza S, Pretorius M, Dawood H, Chhagan M, Haffejee S, Variava E, Kahn K, Tshangela A, von Gottberg A, Wolter N, Cohen AL, Kgokong B, Venter M, Madhi SA. Severe influenza-associated respiratory infection in high HIV prevalence setting, South Africa, 2009-2011. Emerging infectious diseases. 2013 Nov:19(11):1766-74. doi: 10.3201/eid1911.130546. Epub     [PubMed PMID: 24209781]

[60]

Harris CM, Wu HM, Li J, Hall HI, Lee A, Zell E, Harrison LH, Petit S, Farley MM, Lynfield R, Miller L, Nichols M, Reingold A, Schaffner W, Thomas A, MacNeil JR, Clark TA, Cohn AC. Meningococcal Disease in Patients With Human Immunodeficiency Virus Infection: A Review of Cases Reported Through Active Surveillance in the United States, 2000-2008. Open forum infectious diseases. 2016 Oct:3(4):ofw226. doi: 10.1093/ofid/ofw226. Epub 2016 Dec 20     [PubMed PMID: 28018927]

[61]

Konopnicki D, Mocroft A, de Wit S, Antunes F, Ledergerber B, Katlama C, Zilmer K, Vella S, Kirk O, Lundgren JD, EuroSIDA Group. Hepatitis B and HIV: prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort. AIDS (London, England). 2005 Mar 24:19(6):593-601     [PubMed PMID: 15802978]

[62]

Palefsky J. Human papillomavirus-related disease in people with HIV. Current opinion in HIV and AIDS. 2009 Jan:4(1):52-6. doi: 10.1097/COH.0b013e32831a7246. Epub     [PubMed PMID: 19339939]

[63]

Al-Omairi O, Elgalib A, Al Kindi H. HIV Drug Resistance among Patients Failing Therapy at a Tertiary Center in Oman: A Case Record Review. Oman medical journal. 2019 Nov:34(6):490-495. doi: 10.5001/omj.2019.91. Epub     [PubMed PMID: 31745412]

[64]

. Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach. 2021 Jul:():     [PubMed PMID: 34370423]

[65]

Abram ME, Ferris AL, Das K, Quinoñes O, Shao W, Tuske S, Alvord WG, Arnold E, Hughes SH. Mutations in HIV-1 reverse transcriptase affect the errors made in a single cycle of viral replication. Journal of virology. 2014 Jul:88(13):7589-601. doi: 10.1128/JVI.00302-14. Epub 2014 Apr 23     [PubMed PMID: 24760888]

[66]

. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2016:():     [PubMed PMID: 27466667]

[67]

Demeke Bayou F, Nigussie Amare S. Time to Immunologic Recovery and Its Determinant Factors Among Adult HIV Patients Who Initiated Antiretroviral Treatment at Hiwot Fana Specialized University Hospital, Harar, Ethiopia. HIV/AIDS (Auckland, N.Z.). 2021:13():1009-1014. doi: 10.2147/HIV.S336167. Epub 2021 Dec 1     [PubMed PMID: 34880680]

[68]

Gunda DW, Kilonzo SB, Kamugisha E, Rauya EZ, Mpondo BC. Prevalence and risk factors of poor immune recovery among adult HIV patients attending care and treatment centre in northwestern Tanzania following the use of highly active antiretroviral therapy: a retrospective study. BMC research notes. 2017 Jun 8:10(1):197. doi: 10.1186/s13104-017-2521-0. Epub 2017 Jun 8     [PubMed PMID: 28595630]

[69]

Mendicino CCP, Moodie EEM, Guimarães MDC, Pádua CAM. Immune recovery after antiretroviral therapy initiation: a challenge for people living with HIV in Brazil. Cadernos de saude publica. 2021:37(9):e00143520. doi: 10.1590/0102-311X00143520. Epub 2021 Oct 15     [PubMed PMID: 34669770]

[70]

Fan L, Li P, Yu A, Liu D, Wang Z, Wu Y, Zhang D, Zou M, Ma P. Prevalence of and prognosis for poor immunological recovery by virally suppressed and aged HIV-infected patients. Frontiers in medicine. 2023:10():1259871. doi: 10.3389/fmed.2023.1259871. Epub 2023 Oct 19     [PubMed PMID: 37928477]

[71]

Abacavir Therapy and <i>HLA-B*57:01</i> Genotype, Dean L,,, 2012     [PubMed PMID: 28520363]

[72]

Sabin CA, Ryom L, d'Arminio Monforte A, Hatleberg CI, Pradier C, El-Sadr W, Kirk O, Weber R, Phillips AN, Mocroft A, Bonnet F, Law M, de Wit S, Reiss P, Lundgren JD, D:A:D Study Group. Abacavir use and risk of recurrent myocardial infarction. AIDS (London, England). 2018 Jan 2:32(1):79-88. doi: 10.1097/QAD.0000000000001666. Epub     [PubMed PMID: 29028664]

[73]

Nan C, Shaefer M, Urbaityte R, Oyee J, Hopking J, Ragone L, Perger T, Win B, Vangerow H, McCoig C, Vannappagari V. Abacavir Use and Risk for Myocardial Infarction and Cardiovascular Events: Pooled Analysis of Data From Clinical Trials. Open forum infectious diseases. 2018 May:5(5):ofy086. doi: 10.1093/ofid/ofy086. Epub 2018 Apr 20     [PubMed PMID: 29766019]

[74]

Karris MY. Short Communication: Resolution of Tenofovir Disoproxil Fumarate Induced Fanconi Syndrome with Switch to Tenofovir Alafenamide Fumarate in a HIV-1 and Hepatitis B Coinfected Patient. AIDS research and human retroviruses. 2017 Jul:33(7):718-722. doi: 10.1089/AID.2016.0180. Epub 2017 May 12     [PubMed PMID: 28403627]

[75]

Shirasaka T, Tadokoro T, Yamamoto Y, Fukutake K, Kato Y, Odawara T, Nakamura T, Ajisawa A, Negishi M. Investigation of emtricitabine-associated skin pigmentation and safety in HIV-1-infected Japanese patients. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 2011 Oct:17(5):602-8. doi: 10.1007/s10156-011-0222-5. Epub 2011 Mar 3     [PubMed PMID: 21369776]

[76]

Hurst M, Noble S. Stavudine: an update of its use in the treatment of HIV infection. Drugs. 1999 Nov:58(5):919-49     [PubMed PMID: 10595868]

[77]

Butt AA. Fatal lactic acidosis and pancreatitis associated with ribavirin and didanosine therapy. The AIDS reader. 2003 Jul:13(7):344-8     [PubMed PMID: 12889452]

[78]

Tuon FF, Guastini CM, Boulos MI. Acute pancreatitis associated with lamivudine therapy for chronic B hepatitis. The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases. 2008 Aug:12(4):263     [PubMed PMID: 19030723]

[79]

Dheda M. Efavirenz and neuropsychiatric effects. Southern African journal of HIV medicine. 2017:18(1):741. doi: 10.4102/sajhivmed.v18i1.741. Epub 2017 Apr 24     [PubMed PMID: 29568641]

[80]

Valenzuela-Rodriguez G, Diaz-Arocutipa C, Collins JA, Hernandez AV. Weight and Metabolic Outcomes in Naïve HIV Patients Treated with Integrase Inhibitor-Based Antiretroviral Therapy: A Systematic Review and Meta-Analysis. Journal of clinical medicine. 2023 May 24:12(11):. doi: 10.3390/jcm12113644. Epub 2023 May 24     [PubMed PMID: 37297839]

[81]

Stader F, Battegay M, Marzolini C. Physiologically-Based Pharmacokinetic Modeling to Support the Clinical Management of Drug-Drug Interactions With Bictegravir. Clinical pharmacology and therapeutics. 2021 Nov:110(5):1231-1239. doi: 10.1002/cpt.2221. Epub 2021 Mar 29     [PubMed PMID: 33626178]

[82]

Kourtis AP, Zhu W, Lampe MA, Huang YA, Hoover KW. Dolutegravir and pregnancy outcomes including neural tube defects in the USA during 2008-20: a national cohort study. The lancet. HIV. 2023 Sep:10(9):e588-e596. doi: 10.1016/S2352-3018(23)00108-X. Epub 2023 Jul 25     [PubMed PMID: 37506721]

[83]

Calza L, Danese I, Colangeli V, Vandi G, Manfredi R, Girometti N, Borderi M, Appolloni L, Puggioli C, Viale P. Skeletal muscle toxicity in HIV-1-infected patients treated with a raltegravir-containing antiretroviral therapy: a cohort study. AIDS research and human retroviruses. 2014 Dec:30(12):1162-9. doi: 10.1089/aid.2014.0113. Epub     [PubMed PMID: 25369244]

[84]

Teppler H, Brown DD, Leavitt RY, Sklar P, Wan H, Xu X, Lievano F, Lehman HP, Mast TC, Nguyen BY. Long-term safety from the raltegravir clinical development program. Current HIV research. 2011 Jan:9(1):40-53     [PubMed PMID: 21198432]

[85]

DAD Study Group, Friis-Møller N, Reiss P, Sabin CA, Weber R, Monforte Ad, El-Sadr W, Thiébaut R, De Wit S, Kirk O, Fontas E, Law MG, Phillips A, Lundgren JD. Class of antiretroviral drugs and the risk of myocardial infarction. The New England journal of medicine. 2007 Apr 26:356(17):1723-35     [PubMed PMID: 17460226]

[86]

Marin RC, Behl T, Negrut N, Bungau S. Management of Antiretroviral Therapy with Boosted Protease Inhibitors-Darunavir/Ritonavir or Darunavir/Cobicistat. Biomedicines. 2021 Mar 18:9(3):. doi: 10.3390/biomedicines9030313. Epub 2021 Mar 18     [PubMed PMID: 33803812]

[87]

Bissio E, Lopardo GD. Incidence of hyperbilirubinemia and jaundice due to atazanavir in a cohort of Hispanic patients. AIDS research and human retroviruses. 2013 Mar:29(3):415-7. doi: 10.1089/AID.2012.0233. Epub 2012 Nov 28     [PubMed PMID: 23121190]

[88]

. Darunavir. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012:():     [PubMed PMID: 31643326]

[89]

Gulick RM, Lalezari J, Goodrich J, Clumeck N, DeJesus E, Horban A, Nadler J, Clotet B, Karlsson A, Wohlfeiler M, Montana JB, McHale M, Sullivan J, Ridgway C, Felstead S, Dunne MW, van der Ryst E, Mayer H, MOTIVATE Study Teams. Maraviroc for previously treated patients with R5 HIV-1 infection. The New England journal of medicine. 2008 Oct 2:359(14):1429-41. doi: 10.1056/NEJMoa0803152. Epub     [PubMed PMID: 18832244]

[90]

Ball RA, Kinchelow T, ISR Substudy Group. Injection site reactions with the HIV-1 fusion inhibitor enfuvirtide. Journal of the American Academy of Dermatology. 2003 Nov:49(5):826-31     [PubMed PMID: 14576660]

[91]

Iacob SA, Iacob DG, Jugulete G. Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment-Clinical Points of View and Practical Considerations. Frontiers in pharmacology. 2017:8():831. doi: 10.3389/fphar.2017.00831. Epub 2017 Nov 23     [PubMed PMID: 29218008]

[92]

Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV medicine. 2017 Apr:18(4):256-266. doi: 10.1111/hiv.12421. Epub 2016 Aug 31     [PubMed PMID: 27578404]

[93]

Engsig FN, Zangerle R, Katsarou O, Dabis F, Reiss P, Gill J, Porter K, Sabin C, Riordan A, Fätkenheuer G, Gutiérrez F, Raffi F, Kirk O, Mary-Krause M, Stephan C, de Olalla PG, Guest J, Samji H, Castagna A, d'Arminio Monforte A, Skaletz-Rorowski A, Ramos J, Lapadula G, Mussini C, Force L, Meyer L, Lampe F, Boufassa F, Bucher HC, De Wit S, Burkholder GA, Teira R, Justice AC, Sterling TR, M Crane H, Gerstoft J, Grarup J, May M, Chêne G, Ingle SM, Sterne J, Obel N, Antiretroviral Therapy Cohort Collaboration (ART-CC) and the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord. Long-term mortality in HIV-positive individuals virally suppressed for }3 years with incomplete CD4 recovery. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2014 May:58(9):1312-21. doi: 10.1093/cid/ciu038. Epub 2014 Jan 22     [PubMed PMID: 24457342]

[94]

Kelley CF, Kitchen CM, Hunt PW, Rodriguez B, Hecht FM, Kitahata M, Crane HM, Willig J, Mugavero M, Saag M, Martin JN, Deeks SG. Incomplete peripheral CD4+ cell count restoration in HIV-infected patients receiving long-term antiretroviral treatment. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2009 Mar 15:48(6):787-94. doi: 10.1086/597093. Epub     [PubMed PMID: 19193107]

[95]

Greub G, Ledergerber B, Battegay M, Grob P, Perrin L, Furrer H, Burgisser P, Erb P, Boggian K, Piffaretti JC, Hirschel B, Janin P, Francioli P, Flepp M, Telenti A. Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study. Lancet (London, England). 2000 Nov 25:356(9244):1800-5     [PubMed PMID: 11117912]

[96]

Karass M, Grossniklaus E, Seoud T, Jain S, Goldstein DA. Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS): A Rare but Potentially Treatable Condition. The oncologist. 2017 May:22(5):623-625. doi: 10.1634/theoncologist.2016-0237. Epub 2017 Apr 19     [PubMed PMID: 28424322]

[97]

Berhan A, Bayleyegn B, Getaneh Z. HIV/AIDS Associated Lymphoma: Review. Blood and lymphatic cancer : targets and therapy. 2022:12():31-45. doi: 10.2147/BLCTT.S361320. Epub 2022 Apr 29     [PubMed PMID: 35517869]

[98]

Vaccher E, Gloghini A, Carbone A. HIV-related lymphomas. Current opinion in oncology. 2022 Sep 1:34(5):439-445. doi: 10.1097/CCO.0000000000000890. Epub 2022 Jul 27     [PubMed PMID: 35900752]

[99]

Sax PE, Erlandson KM, Lake JE, Mccomsey GA, Orkin C, Esser S, Brown TT, Rockstroh JK, Wei X, Carter CC, Zhong L, Brainard DM, Melbourne K, Das M, Stellbrink HJ, Post FA, Waters L, Koethe JR. Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020 Sep 12:71(6):1379-1389. doi: 10.1093/cid/ciz999. Epub     [PubMed PMID: 31606734]