Principes des traitements des patients infectés par le VIH

HIV infection has become a chronic disease since the amendment of efficient antiretroviral therapy. Modern treatments reduce and control the viral load significantly as to allow a solid immune response. Initiation of first-line antiretroviral treatments is now clearly established; it combines two nucleoside inhibitors of the HIV reverse transcriptase with either one of a non-nucleoside inhibitor or an HIV protease inhibitor. There is no combination applicable to every patient; the choice must take into account the possible and/or expected adverse effects. One must insist on the patient's observance and adherence to his treatment. The decision of treatment initiation, modification or interruption must be taken in collusion with the patient. A better knowledge of adverse effects allows a better follow-up and thereby improves observance. Pregnancy and antiretroviral therapy can be compatible. Furthermore a proper medical monitoring during pregnancy has reduced mother-child transmission under 2%. Undertaking of associated infections by viral hepatitis is now better defined and treatment remains delicate although it has largely been eased.