FIGURE 2-2 Estimated numbers of U.S. AIDS case reports and death certificates in which HIV disease was selected as the underlying cause of death, 1987–2006.

FIGURE 2-2 Estimated numbers of U.S. AIDS case reports and death certificates in which HIV disease was selected as the underlying cause of death, 1987–2006.

SOURCE: Centers for Disease and Control and Prevention, 2007.

infection when single-drug or dual-drug therapy was used. Now it is less of a problem with the use of potent combination regimens (Bangsberg et al., 2000, 2003, 2004). Although only some viruses are resistant to all current antiretroviral drugs, it is possible that such strains will become more prevalent in the future. CD4 count and viral load are currently the leading laboratory indicators of the progression of HIV infection (see Chapter 3). Other independent indicators include hemoglobin and direct markers of inflammation and coagulation.

Treatment Side Effects

Although they save lives, antiretrovirals have a variety of side effects, some of which can be permanently disabling. Further complicating the picture is the fact that some side effects from treatment resemble manifestations of HIV/AIDS; as a result, clinicians may have trouble determining whether the root cause of the symptom is the antiretroviral or the underlying disease. Given the array of antiretrovirals currently available (see Table C-2 for a list of current HIV/AIDS antiretrovirals and potential side effects), one is often able to switch to an alternative regimen to attempt to distinguish a side effect from a disease manifestation. Some of the formerly common side effects from treatment are now relatively rare. For example, pancreatitis and kidney stones are no longer common complications of HIV/AIDS therapy.

Under certain circumstances, patients continue to be disabled by HIV/ AIDS, despite advances in treatment and the opportunity to choose alternate medications (Klimas et al., 2008). Although currently the overall out-



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