Figure 739

Antiretroviral therapy. Recommended antiretroviral therapy for patients with HIV infection without renal disease includes therapies with two drugs for all patients, combining two reverse transcriptase inhibitors. Aggressive early intervention with triple antiviral drugs, one of which is a protease inhibitor, should be offered to patients symptomatic of AIDS, asymptomatic patients with CD4 counts under 500/^L, and asymptomatic patients with CD4 counts over 500/^L and plasma HIV RNA levels over 20,000 copies/mL [195]. Reduced dosages are required for reverse transcriptase inhibitors in renal insufficiency. Although the clearance information on these drugs is limited, additional dosing is not necessary in patients receiving maintenance dialysis. No dosage reduction is needed for protease inhibitors.

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