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Potential benefits of initiating therapy at any stage of acute infection include: reducing the severity of clinical manifestations of the acute stage; lower HIV-VL and shrink the size of the HIV reservoir; decrease in the rate of genetic evolution of the virus; decreased levels of immune activation and systemic inflammation; preservation of immune function and integrity of lymphoid tissue; protection of the nervous system; prevention of damage to the lymphoid apparatus of the intestine.
not recommended that physicians responsible for the care of HIV-infected patients make decisions to refuse initiation of ART based only on the level of HIV-VL [97] (2A).
Comments: A VL level of more than 100,000 copies/mL is considered poor prognostic, but even at low VL levels, the disease may have a progressive course.
Starting ART reduces systemic inflammation and reduces immune reactivation, minimizing the risk of disease.
The period between the diagnosis of HIV infection and the initiation of ART should be as short as possible [88,96] (2A).
If the patient is ready to start ART and there is his consent, treatment can be started immediately, immediately after diagnosis, if there are no clinical contraindications for taking antiretroviral drugs [88,96].
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 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 Buy Cozaar (Losartan) 25mg, 50mg, 100mg online - Blood Pressure 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”.