Symptomatic patients

There is consensus that every patient with HIV-associated symptoms should receive antiretroviral therapy. This is mainly true for patients in CDC Stage C (with AIDS), but also for Stage B. Although this should be correct in most cases, it may be advisable to consider the situation more closely in individual cases. To avoid misunderstanding: all Ols, which only occur in severe immunodeficiency, such as CMV, MAC or PCP, and also AIDS malignancies (including the non-AIDS-defining Hodgkin's Disease), should therefore prompt rapid initiation of therapy, especially, as in the case of PML, if there is no specific treatment available. In these cases, rapid initiation of HAART is the only treatment option available.

However: Herpes zoster (Stage B) may occur even with a slight immune defect and does not necessarily indicate immunological deterioration. Thrombocytopenia or constitutional symptoms may also have other causes. A further example: tuberculosis (TB), which is an AIDS-defining illness and therefore an "urgent" indication for therapy, can occur as a facultative opportunistic infection, without or with only moderate immunodeficiency. Waiting with HAART can be justified in a TB patient with good CD4 cells (see example in Table 5.3).

Table 5.3: Case study, in which HIV treatment, if it had been given in accordance to the guidelines, could have led to almost eleven years of over-treatment. NA = not available

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