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

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Discover The Secrets To Become Fertile Dr Paras Shah Chief Consultant Sexologist & Fertility Specialist Sal Hospital Rajasthan Hospitalwww.s4sq.com "so, When Are You Planning To Have A Baby?" This Is The Commonest Question Most Newly Married Couples In India Are Asked - Sometimes Even As Soon As They Have Returned From The Honeymoon! There Is A Lot Of Pressure On Couples To Have A Baby, Especially In Traditional Families, Where The Wife's Role Is Still Seen To Be One Of Perpetuating The Family Name By Producing Heirs. Many Couples Still Naively Expect They Will Get Pregnant The Very First Month They Try (the Result Of Watching Too Many Hindi Films, Perhaps!) And Are Concerned When A Pregnancy Does Not Occur. They Go Through A Brief Interlude Of Doubt And Concern When They Do Not Achieve Pregnancy The Very First Month They Try And Start Wondering About Their Fertility. Like A Surprising Number Of Couples These Days You've Been Hit With A Bolt Out Of The Blue... You're Infertile. Whether You're Newly Diagnosed Or Have Been Dealing With The Discovery For A While Now, What You Learn Here Will Make All The Difference In Whether You Ever Hear Your Own Child Call You "dad Or Mummy". Before Worrying, Remember That In A Single Menstrual Cycle, The Chance Of A Perfectly Normal Couple Achieving A Successful Pregnancy Is Only About 25%, Even If They Have Sex Every Single Day. Getting Pregnant Is A Game Of Odds - It's A Bit Like Playing Russian Roulette And It's Impossible To Predict When An Individual Couple Will Get Pregnant! However, Over A Period Of A Year, The Chance Of A Successful Pregnancy Is Between 80 And 90%, So That 7 Out Of 8 Couples Will Be Pregnant Within A Year. These Are The Normal "fertile" Couples - And The Rest Are "labeled" Infertile - The Medical Text Book Definition Of Infertility Being The Inability To Conceive Even After Trying For A Year. Like More Than Ten Million Other Indians, Rakesh And Jolly Desperately Wanted A Baby But Couldn't Seem To Conceive. After A Consultation, They Were Sent Home With Doctor's Orders: Have Sex When Jolly Was Most Fertile, And Have It Often. While That May Sound Like A Dream Come True, Infertile Couples Like The Priya Say It Can Be Stressful. "i Didn't Want To Be One Of Those Women Tapping On Her Watch, Saying 'now' At The Bedroom Door," Says Jolly, "so I Tried To Be Seductive In Creative Ways." They Both Put More Emphasis On Foreplay, For Instance, So They Didn't View Each Other Simply As An Egg Manufacturer And A Sperm-delivery Guy. "i'd Try To Think Of My Husband As A Sexy Man, Not Just The Guy Who Didn't Get Me Pregnant," Says Jolly. "sometimes, Before Intercourse, I'd Focus On Some Physical Aspect Of Him That I Particularly Adore, And That Would Turn Me On." Obviously, It Worked -- The Priyas' Daughter, Vidhi, Is Now Three. The Stopwatch Mentality Sex Can Become Tedious When They Have To Time Intercourse To Accommodate Numerous Lab Tests Or Maximize Their Chances Of Success. Spontaneity Can Be Replaced With Sex As A Compulsory Act Sex On A Schedule. Besides This Timetable Pressure, There Can Be Loss Of Self-esteem (if, For Instance, The Woman Feels Like A Failure For Not Becoming Pregnant) And The Financial Burden Of Fertility Treatments. But Through It All, There Are Ways To Minimize The Toll. How Women And Men Respond First, A Couple Should Understand That Each Of Them Tends To React A Bit Differently, Experts Say. "a Woman In This Situation May Feel Alienated From Her Body, So It May Be Hard For Her To Feel Sexual," Says Dr Archana Shah, Consultant Gynecologist And Fertility Specialist, Rajasthan Hospital, Ahmedabad. "she May Feel Like Little More Than A Set Of Ovaries And Even Begin Asking Herself, 'what's The Point Of Having Sex If I'm Not Getting Pregnant?' " Lack Of Desire, In Turn, Can Decrease Natural Lubrication, Making Sex Painful, Dr Archana Says, And Resulting In Even Less Sex. In Addition, A Man May Feel Like Nothing More Than A Sperm Donor And Become So Distanced That He Has Difficulty Achieving Erection Or Orgasm. Some Men Even Fake Orgasm To Get Sex Over With. Relieving The Pressure Both Partners Should Avoid Getting Into "performance" Mode. It Can Help To Realize That The Window Of Opportunity For Conception Stays Open Longer Than What Is Suggested In Movies, Where Characters Often Engage In Lunch-hour Sex In Order To Conceive While The Woman Is Fertile. Sperm Can Live In The Cervical Mucus For About Two Days Before Ovulation, According To Dr Archana. In General, Infertile Couples Are Advised To Have Intercourse Between 12th And 18th Day Of Her Period, If Possible Every Other Day. These Are The Fertile Days For Her. Simply Stated, The More Sex The Better! Couples Who Have Intercourse Less Frequently, Have A Diminished Chance Of Conceiving. I Tell All My Patients – It’s Much More Fun Making A Baby In Your Bed Room Than Coming To Me! (and Think Of All The Money You’ll Be Saving – It’s Like Being Paid To Make Love To Your Wife !) Also Remember That You Cannot "store Up" Sperm, Which Means That There Is Really No Advantage To Abstaining From Sex If You Are Trying To Conceive. In This Case, More Is Better, And In Fact Studies Have Shown That Fresh Sperm Have A Better Chance Of Achieving A Pregnancy Than Sperm Which Have Been Stored Up For Many Days. However, Sex Shouldn't Be Confined To The Time Of Fertile Days. Unless Instructed Otherwise By Their Doctor, Couples Should Make Love Throughout The Month, Not Just When They Think They Might Conceive. That Might Help Them Separate Sex From Conception And Sex Will Become A Natural Part Of Life Again. Sex As Recreation, Not Just Procreation Thinking Of Sex Not As A Chore But As Fun, The Way It Used To Be, Can Help. "we Did Our Best To Have A Good Time -- Having Sex In Different Rooms, Different Positions And Go To Even Hill Station," Mahi Recalls. Couple Should Set A Romantic Mood With Things Like Shared Baths And Massages. It's Also A Good Time To Explore Sexual Fantasies And Erotica. If You Have Been Having Sexual Intercourse Two Or Three Times A Week At About The Time Of Ovulation, Without Any Form Of Birth Control For A Year Or More And Are Not Pregnant, You Meet The Definition Of Being Infertile. Pregnancy May Still Occur Spontaneously, But From A Statistical Point Of View, The Chances Are Decreasing And You May Now Want To Start Thinking About Seeking Medical Help. There Is No "right" Time To Do So And If It Is Causing You Anxiety And Worry, Then You Should Consult A Doctor. Even Though You May Be Embarrassed And Feel That You Are The Only Ones In The World With The Problem, You Are Not Alone. Many Couples Experience Infertility And Most Of Them Can Be Helped. Unfortunately, While Infertility Is Always An Important Problem, It Is Usually Never An Urgent One. This Often Means That Couples Keep On Putting Off Going To The Doctor. "we'll Take Care Of It Next Month". Tragically, Many Find That Time Flies, And Before They Realize It, Their Chances Of Getting Pregnant Have Started To Decline, Even Before They Have Had A Chance To Take Treatment Properly. Set Your Priorities, So That You Have Peace Of Mind That You Tried Your Best. After All, If You Don't Take Care Of Your Own Infertility Problem, Who Will ? Kicking Yourself When You Are 40 Years Old For Failing To Take Treatment When You Were Younger Will Not Help. Remember That Everything In Life Comes Back, Except For Time! Staying Positive And Looking Ahead To The Day Would Hold A Brand-new Family Member In Your Arms.