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EFV** at a dose of 400 mg once a day, can be prescribed to everyone, except for patients with tuberculosis receiving tuberculostatics, and pregnant women (due to insufficient knowledge of the pharmacokinetics of a reduced dose in patients of these groups) [140,141] (2B) Not recommended for physicians responsible for surveillance of HIV-infected patients, administer EFV** at a dose of 400 mg or 600 mg in areas with a high (>10%) prevalence of primary NNRTI drug resistance to avoid treatment failure [140,141,146,147] (2B).
not recommended for physicians responsible for monitoring HIV-infected patients with VL >100,000 kop/ml to prescribe the ABC** + 3TC** (or FTC) + EFV** regimen, as well as RPV/TDF/FTC** (if there are more CD4 50 copies/ml Repeated (with an interval of 2-4 weeks) detection of detectable levels of VL (more than 50 copies / ml) after 6 or more months of ART in patients with achieved virological suppression Switching to second-line ART with good adherence (resistance test).
If violations of adherence are identified, preliminary work to improve adherence Immunological failure clear criteria missing Decrease in CD4 to baseline and below or persistent CD4 count-1 500 µl -1 ; absence of clinical manifestations of secondary diseases during the last 6 months; lack of resistance to IP, AI, multiple resistance; absence of chronic viral hepatitis B; no pregnancy.
Treatment of secondary and concomitant diseases in HIV infection.
Therapy and treatment regimens for secondary diseases most frequently reported in HIV-infected patients The severity of the patient's condition can initially be determined by the presence of secondary and concomitant diseases, the treatment of which in most cases takes precedence over the initiation of ART and plays an important role in the treatment of patients with HIV infection.
recommended that physicians responsible for monitoring HIV-infected people, in addition to ART in patients with a CD4 count 200 cells/?L for 3 months or CD4+ lymphocyte count 100–200 cells/?L and undetectable HIV RNA level for 3 months #Co-trimoxazole [Sulfamethoxazole+Trimethoprim]** 400/80 mg once daily [228] (2B) or 800/160 mg once daily 3 times a week. #Dapson 100 mg (2 tablets) once daily PO daily [227] (2B).
(with intolerance to Co-trimoxazole [Sulfamethoxazole+Trimethoprim]**) Treatment #Co-trimoxazole [Sulfamethoxazole + Trimethoprim]**, based on trimethoprim 15 - 20 / 75 - 100 mg / kg per day orally or intravenously (daily dose is divided into 3 - 4 injections) for 3 weeks #Dapson** 100 mg OD po trimethoprim 5 mg/kg 3 times po po for 21 days Comments: prophylaxis is carried out until CD4 > 200 µl -1 and undetectable HIV-VL for more than 3 months.
prednisolone 1 mg/kg is prescribed, followed by a dose reduction, as well as oxygen therapy.
recommended to carry out primary prevention (preventive treatment) of toxoplasmosis with a CD4 count 200 µl-1 and undetectable HIV-VL for 3 months. Treatment of toxoplasmosis (the cerebral form is more often diagnosed) is recommended at the slightest suspicion of a disease, without waiting for the results of the examination. [108, 232, 233] (5C): Choice regimen: Co-trimoxazole [Sulfamethoxazole+Trimethoprim]**, 25/5 mg [OAS4] [EC5]/kg po. Or Co-trimoxazole [Sulfamethoxazole+Trimethoprim]** IV drip Starting dose was 50/10 mg/kg/day or 75/15 mg/kg/day in two divided doses until clinical improvement (usually 3-5 days), then 37.5 / 7.5 mg / kg / day per day for at least 6 weeks. (until elimination of at least 75% of lesions on MRI of the brain).