Table III

U.S. Federal Guidelines for Initial Treatment of HIV Infection

One from group A (highly active protease inhibitors) and one combination from group B (NARTIs):

Group A Group B

Indinavir AZT + ddl

Ritonavir d4T + ddI

Nelfinavir AZT + ddC

Saquinavir SGC AZT + 3TC

A combination of ritonavir + saquinavir that may be neurotoxic (e.g., lymphokines and quino-linic acid), they may also alter their production of trophic factors that are necessary to sustain neurons. Examples of immune signaling molecules that can be damaging to neurons include tumor necrosis factor-alpha (TNF-a) and interleukin-6.

Masliah and colleagues suggested that different neuronal populations may be sensitive to differing types of injury. For example, pyramidal neurons may be particularly sensitive to NMDA-linked excitotoxic injury. However, interneurons, that are also damaged in HIV disease, contain proteins such as calbindin and parvalbumin that tend to protect against disruptions of calcium homeostasis. Masliah and colleagues argue that these neurons may be more vulnerable to damage by inflammatory mechanisms.

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