title: Antiretroviral therapy in treatment-naïve patients with HIV infection.
abstract: OBJECTIVE
  This review discusses the current status of antiretroviral therapy (ART) in treatment-naïve patients. ART initiation in such patients needs to be carefully planned, as the aim of therapy has shifted from prolonging life to ensuring maintained adherence to ART and optimization of quality of life. There is a plethora of first-line antiretroviral agents available, and physicians must consider several patient-related and therapy-related factors before selecting the most appropriate initial ART.
  
  
  RESULTS
  Current treatment guidelines recommend the use of nonnucleoside reverse transcriptase inhibitor (NNRTI), ritonavir-boosted protease inhibitor (PI), or integrase strand transfer inhibitor (INSTI)-based regimens in treatment-naïve patients. Treatment selection and modification to achieve optimal response is based primarily on regular assessment of viral load (and resistance testing if necessary) and CD4 cell count. The use of genotypic resistance testing, on initiation of therapy and on treatment failure, is becoming more widespread. In selected patients, due to increasing transmitted drug resistance (TDR), a PI-based regimen may be a better option. Classic ART combinations are being challenged by new combinations, although there is currently insufficient evidence to recommend use of the newer over classic combinations. Co-formulations of drugs and single-tablet regimens are fast becoming available and their convenience may increase patient treatment adherence.
  
  
  CONCLUSIONS
  All drug classes currently available for first-line ART are efficacious and have good tolerability; however, differences between individual drugs must be carefully considered when deciding a first-line regimen. Each first-line regimen must be tailored to the individual patient to attain optimal efficacy, acceptable long-term tolerability, and good adherence to ART.
authors.affiliation: Molecular Biology Laboratory, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Camacho
authors.forename: Eugénio
authors.initials: E
authors.lastname: Teófilo
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D018791:CD4 Lymphocyte Count; D016903:Drug Monitoring; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D055118:Medication Adherence; D011788:Quality of Life; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents