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3 - General principles of pharmacotherapy for the patient with HIV infection

Published online by Cambridge University Press:  06 August 2009

By
Sanjay M. Sharma M.D., M.B.A. ,
J. Stepen McDaniel M.D.  and
Nancy L. Sheehan B.Pharm., M.Sc.
Edited by
Kenneth Citron ,
Marie Josée Brouillette  and
Alexandra Beckett
Sanjay M. Sharma M.D., M.B.A.
Affiliation:
Assistant Professor, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
J. Stepen McDaniel M.D.
Affiliation:
Professor, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
Nancy L. Sheehan B.Pharm., M.Sc.
Affiliation:
HIV Pharmacotherapy Specialist, McGill University Health Centre, Montréal, Canada
Marie Josée Brouillette
Affiliation:
McGill University, Montréal
Alexandra Beckett
Affiliation:
Harvard University, Massachusetts
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Summary

Introduction

Over the past several years, highly active antiretroviral therapy (HAART) has become the pharmacological mainstay in the ongoing management of HIV infection and AIDS. This treatment regimen comprises a combination of antiretroviral medications which fall into four major classes including nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and entry inhibitors (Table 3.1). Each medication within its respective class acts to inhibit the replication process of HIV at a distinct point in its viral life cycle. When used in combination therapy, these medications form a highly effective and powerful tool in the treatment of HIV infection and AIDS.

However, as effective and beneficial as these combination antiretroviral treatments are, the ongoing management of HIV infection may be complicated by potential side effects and drug–drug interactions.

In addition to being concerned about the impact of antiretrovirals on psychotropic medications, the clinician has to ensure that the psychopharmacological agents do not compromise HIV treatment or lead to the development of resistant strains of the virus.

This chapter:

  • describes the various potential drug–drug interactions and neuropsychiatric side effects that may occur when psychotropic medications, narcotics, recreationally used/abused drugs, and alternative agents are utilized concomitantly with antiretroviral treatment

  • offers practical recommendations on choosing psychotropic medications for a variety of psychiatric illnesses while respecting issues of safety and not compromising HIV care.

Type
Chapter
Information
HIV and Psychiatry
Training and Resource Manual
 , pp. 56 - 87
Publisher: Cambridge University Press
Print publication year: 2005

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