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Patients Must Be Told To Undertake Lifelong Art. Start Treatment For Symptomatic Patients Regardless Of Cd4 Cell Count. Start Drugs For Asymptomatic Individuals With Cd4 Cell Counts <500/l. Do Risk Reduction Counseling At Each Patient–clinician Interaction. Regimen: Consider Resistance–testing Results And Predicted Virologic Efficacy, Toxicity And Tolerability, Pill Burden, Dosing Frequency, Drug–drug Interactions, Comorbidities, Patient And Practitioner Preference, And Cost And Affordability. Combine Two Nucleoside Reverse Transcriptase Inhibitors And A Potent Third Agent From Another Class. Prefer A Fixed–dose Formulations And Once–daily Regimen. Suppress Hiv To Less Than 50 Copies/ml (polymerase Chain Reaction) Or 75 Copies/μl (branched Dna) By 24 Weeks. To Detect Failure: Repeat Testing Of Hiv–1 Rna 2 To 8 Weeks After Initiation, Every Four To Eight Weeks Until Suppressed, And Then Every 3 To 4 Months For At Least The First Year. Monitor Cd4 Cell Counts At Least Every 3 To 4 Months After Starting Therapy, Especially In Patients With Counts <200/μl, To Assess Whether Prophylaxis Is Needed For Opportunistic Infections. Do More Frequent Monitoring In Patients Who Have Changed Therapy Because Of Virologic Failure. Even If One Or More Regimens Have Failed, The Therapeutic Goal Should Still Be Undetectable Plasma Hiv–1 Rna Levels. Achieve This Goal With New Drugs And Regimens. If An Elevation In Viral Load Occurs After Complete Suppression Is Achieved, Consider Poor Adherence, Drug–drug Interactions, Concurrent Infections And Recent Vaccinations As Possible Causes Before Changing Regimens. Repeat Testing For An Isolated Detectable Viral Load To Exclude Errors Or Self–resolving Low–level Viremia. When Changing Regimens After First– Or Multiple–regimen Failure, Consider The Stage Of Hiv, Nadir And Current Cd4 Cell Count, Comorbidities, Treatment History, Current And Previous Drug Resistance Tests, And Drug Interactions. Include At Least Two Drugs, And Preferably Three Fully Active Drugs Or Drugs From New Classes. Single–agent Switches To Decrease Toxicity, Avoid Drug Interactions, Or Improve Convenience And Adherence Are Possible, Provided The Potency Of The Regimen Is Maintained And Drug Interactions Are Managed. Boosted Protease Inhibitor Monotherapy Is Not Recommended, Except When Other Drugs Raise Issues Of Toxicity Or Tolerability. Delaying Such Switches May Affect Adherence And Risk Development Of Resistance

The Medical Care Of The Child During Its First Two Years Of Life Not Merely Requires Of The Physical, But Also Of The Mental Health And Development. This Begins, Not At The Time Of Birth But In Utero. It Is Essential To Guard The Health Of The Mother During Pregnancy, Her Mental And Physical If The Best Possible Child Is To Be Born. There Are Various Disabilities From Which The Mother May Suffer Which Have An Adverse Effect On The Unborn Infant. Some Are Conditions Peculiar To Pregnancy: Others Are Ailments Which Attack Indiscriminately The Pregnant And Non-pregnant. Let Us Take First A Few Of The Conditions Peculiar To Pregnancy. On The Physical Side We Have Excessive Vomiting, Albuminaria, Constipation With Toxic Absorption, Or Diarrhoea. On The Mental Side There Are Such Things As Undue Depression, Morbid Fears, Sleeplessness, And The Effects Of Frights. In This Sphere Homoeopathy Has Much To Offer In Advance Of Ordinary Medicine. For Example: Excessive Vomiting Of Pregnancy, If Allowed To Continue, Will Lead To The Death Of The Foetus, Either Naturally, Or Artificially Induced To Save The Life Of The Mother. In A Very Large Percentage Of Cases, When The Vomiting Of Pregnancy Starts, A Few Homoeopathic Doses Of Ipecacuanha Will Completely Control It. The Danger Is Prevented And Does Not Need To Be Met. In Those Unfortunate Cases In Which The Condition Has Not Been Homoeopathically Treated From The Start, The Response To The Homoeopathic Drug Is Startling, Though The Choice Of The Drug Is More Difficult And Is Dictated By The Symptoms Of The Individual Case. Albuminuria Of Pregnancy Is One Of The Terrors Of The Obstetrician. It Is One Of The Great Danger Signals, One Of The Signs That The Strain Is Telling On The Mother, And Through Her On The Child. It Is The Precursor Of Convulsions With All Their Horrors And Anxieties. Small Pills Of Homoeopathy Remedies Like Apis, Plumbum, Acidum Phosphoricum Or Terebinthina Remove The Albumin From The Urine And Make The Case Settle In No Times. Constipation In Pregnancy Is A Common Trouble. Where It Exists Toxic Absorption Is Bound To Follow, And While It Persists The Patient Is In Danger Of The Severer Complications Due To Infection By The Bacillus Coli. In The Great Majority Of Cases A Few Doses Of Nux Vomica, Opium, Or Alumina Will Put Matters Right, Provided The Mother's Diet Is Rational. Diarrhoea In Pregnancy Is Always A Serious Matter, And If Not Speedily Relieved May Lead To Miscarriage. The Gentle Action Of A Small Dose Of Aloe, Podophyllum Or Mercurius Can Give An Instantaneous Relief. Rubella, Or German Measles If Acquired During Pregnancy, Especially During The First Four Months, May Have An Adverse Effect On The Unborn Child. In The Event Of Exposure To Infection During Pregnancy It Would Be Wise To Prescribe The Rubella Nosode. On The Mental Side The Effects Of Morbid States In The Mother Have A Very Definite Effect On The Foetus. The Morbid Depression Will Fade Away After The Judicious Administration Of Pulsatilla, Aurum, Or Sepia. Fears Lose Their Terror Under The Action Of Aconitum Napellus, Arsenicum Album, Argentum Nitricum, Ignatia Amara Or One Of The Dindred Drugs. Sleep Returns To The Weary Mother Helped By Aconitum Napellus, Belladonna, Coffea Cruda, Nux Vomica, Etc., And The Fright Loses Its Evil Effect Under The Sedative Influence Of Aconitum Napellus, Ignatia Amara, Opium, Phosphorus, Pulsatilla Nigricans, Etc. The Mother's Nervous System Has Not Been Dulled, Not Has The Unborn Infant Been Poisoned By Any Of These Drugs. The Next Factor Seriously Affecting The Well-being Of The Child Is Its Birth. Here There Are Great Possibilities Of Injury; Unavoidable Injury At The Hands Of The Most Skilful Attendant, Due To The Necessity For Manipulation Of Instruments, Or Injury Due To Prolonged And Difficult Labour, Without Any Outside Interference. These Injuries May Be To Limbs Or, Much More Serious, May Involve Intracranial Haemorrhages And Consequent Brain Damage. There Are Two Problems To Be Considered Here: How To Avoid The Risk, If Possible; And What Can Be Done For The Infant Who Is Suffering From The Effects Of A Difficult Labour. It Is An Experience Common To Homeopathic Doctors Everywhere, Who Are Conducting A General Practice, That Their Patients Do Not Suffer From Difficult Labour. That Does Not Prove Anything, But It Is A Fortunate Fact For The Patients. There Are Two Factors Which Have A Bearing On This Happy Experience: A Pregnant Woman Who Is Treated Throughout Her Pregnancy With Homoeopathic Medicine Will Approach Her Confinement Freed From The Physical And Mental Ailments Which So Often Are Factors In The Production Of An Unsatisfactory Confinement; And, There Is A Drug, Caulephyllum, Which Has The Power Of Regulating The Processes Of Labour, A Fact Which Was Known And Used By Homoeopaths Many Years Ago, And Is Equally True To-day.