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recommended that physicians responsible for the care of HIV-infected people delay initiation of ART in the following cases : in a serious condition of the patient requiring stabilization Buy Paxil (Paroxetine) 10mg, 20mg, 30mg, 40mg online - Anti-Depressants of vital functions, urgent etiotropic treatment of secondary or concomitant diseases (tuberculosis, CNS lesions, etc.), in the presence of a high risk of lethal complications of ART due to the development of a life-threatening inflammatory syndrome of immune system recovery . [102,103] (2B) Comments: If active tuberculosis is detected in a patient, treatment should be started and then ART should be added: if the CD4 count is 50 µl -1 - no later than after 8 weeks.

If a patient is diagnosed with cryptococcal meningitis, treatment is initiated and ART added after improvement, usually after 2–10 weeks of antifungal treatment.

Recommendations to delay treatment in these cases are aimed at reducing the risk of life-threatening immune reconstitution syndrome, and are based on the lack of evidence of a reduction in mortality in these patient groups with earlier initiation of ART 6 . if an HIV-infected woman is pregnant in the first trimester [104] (2C); Comments: Given the low rate of mother-to-fetal transmission of HIV up to 13 weeks' gestation, and to avoid potential fetal exposure to ARVs, ART may be deferred until the end of the 1st trimester of pregnancy unless prompt initiation of ART is indicated.

Comments: Patients with undetectable VL and high CD4 counts (> 500 ?l -1 ) in the absence of ART during follow-up have a low risk of progressing HIV infection. In order to avoid side effects of ARVs and in the absence of any indication for initiation of ART, except for the presence of HIV infection, treatment may be delayed until the indication becomes available.

A prerequisite for making a decision is the presence of regular dispensary observation of the patient with the possibility of studying CD4 and VL.

At the same time, it should be explained to the patient that the absence of therapy entails an increase in the level of systemic inflammation and an increase in the risks of concomitant diseases, even with “elite control”. recommended to physicians responsible for the observation of HIV-infected people before starting ART to conduct a survey of patients in the scope of dispensary observation .

[3,5,37,57,108,109,110,111,112] (1A) Comments: The examination is carried out to obtain baseline data that will allow assessing the safety and efficacy of the therapy. According to the results of clinical laboratory and instrumental studies, the state of the main organs and systems of the body (CNS, hematopoiesis, kidneys, liver, lungs, CVS), the presence of concomitant and secondary infections (CVH B and C, tuberculosis, toxoplasmosis) and conditions (pregnancy), as well as viral replication activity (VN) and severity of immunosuppression (CD4 level).