How to judge the effectiveness of antiviral treatment after HIV-infected patients take the medication, what kind of treatment is considered to have failed, what to do after failure, do all need to change the medication?
We all know that antiviral therapy can prolong the life of HIV-infected patients, can improve the quality of life, and can reduce the infectiousness of the surrounding people, so what effect can an effective antiviral treatment program achieve?
Generally speaking, in HIV-infected patients, the viral load should drop by more than 1 log after 4 weeks of antiviral treatment time, and after 3-6 months of treatment, the viral load should reach undetectable levels. The infected person’s infectiousness will also be greatly reduced, and the risk of transmission to those around them is subsequently reduced or even eliminated. It is often said that treatment is the best prevention – treatment for the infected person is also prevention for the non-infected person.
If the treatment is effective, in addition to the reduction in viral load, another change is the recovery of immune function; CD4+ T lymphocyte counts should increase by 30% after 3 months of treatment, or by 100 cells/ul after 1 year of treatment. If laboratory tests for viral load and CD4+ T lymphocytes are not readily available, observing body weight is the shortest and easiest. Weight gain is the most sensitive indicator of treatment effectiveness. If viral load remains greater than 200 copies/ml at 48 weeks after treatment, treatment virology is considered to have failed.
Once treatment failure is determined, instead of rushing to change the medication, the reasons need to be analyzed. The first step is to understand adherence, that is, whether the infected person has adhered to taking the medication on time and regularly, and if more than 1 time a month is missed, the risk of treatment failure is elevated. In China, due to the differences in age, gender, education and personality of infected patients, the compliance varies greatly. In practice, we find that many people do not know which drugs they are taking, cannot name the drugs, and do not know the importance of adhering to regular medication.
If compliance is not a problem, it is also important to consider whether there are drug interactions that affect the therapeutic effect of anti-disease drugs. If the above two points are ruled out, then we should consider whether the virus is resistant to antiviral drugs, and it is best to do a drug resistance test. Choose a drug change regimen based on the resistance results. In a new regimen, it is best to switch to a drug that is effective for all 3 drugs, or at least 2 drugs that are not resistant, depending on the results of the drug resistance test. With the new regimen, it is best to include kleenex.
After changing the regimen, the efficacy should also be observed as described above, and if it fails again, the regimen should be adjusted according to the above principles.