Congress passed the Education for All Handicapped Children Act in 1975 to meet the special educational needs of children who are mentally retarded, hard of hearing, deaf, speech impaired, visually handicapped, seriously emotionally disturbed, or orthopedically impaired, or other health impaired children, including children with AIDS, or children with specific learning disabilities.
efavirenz DuPont Pharmaceutical's once-a-day nonnucleoside reverse transcriptase inhibitor (NNRTI) for combination use with other antiretro-viral agents for adults and children with HIV infection. Ways to add efavirenz that are supported by clinical data include combination with only a protease inhibitor, with a protease inhibitor plus one or more nucleoside analogs, or with two nucleoside analogs alone. The simplest regimen is to spare the nucleoside analogs and use efavirenz plus a protease inhibitor only. Efavirenz when added to protease inhibitor plus nucleoside analogs provides extra insurance as first-line therapy and succeeds in many instances as salvage therapy for people for whom protease inhibitors fail whether because of viral rebound or of side effects. Individuals who do not obtain adequate HIV suppression with protease inhibitors may have no choice but to move to a protease-sparing regimen.
Efavirenz stays in the body for a long time and therefore is taken only once a day. Before replacing a protease inhibitor with efavirenz, one should remember that efavirenz can have toxicities. Efavirenz is associated with a rise in cholesterol and triglycerides, unlike other NNRTIs. First, it is not yet clear whether the lipid abnormalities observed with protease inhibitors are due to these compounds' effect on the liver or are a less obvious side effect or lingering consequence of long-term HIV infection. Besides profoundly inhibiting HIV, efavirenz does
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