Challenges in initiating antiretroviral therapy in 2010.
Many clinical trials have shown that initiating antiretroviral therapy (ART) at higher rather than lower CD4 T cell-positive counts results in survival benefit. Early treatment can help prevent end-organ damage associated with HIV replication and can decrease infectivity. The mainstay of treatment is either a non-nucleoside reverse transcriptase inhibitor or a ritonavir-boosted protease inhibitor in combination with two nucleoside reverse transcriptase inhibitors. While effective at combating HIV, ART can produce adverse alterations of lipid parameters, with some studies suggesting a relationship between some anti-retroviral agents and cardiovascular disease. As the HIV-positive population ages, issues such as hypertension and diabetes must be taken into account when initiating ART. Adhering to ART can be difficult; however, nonoptimal adherence to ART can result in the development of resistance; thus, drug characteristics and the patient's preparedness to begin therapy must be considered. Reducing the pill burden through the use of fixed-dose antiretroviral drug combinations can facilitate adherence.
Division of Infectious Diseases, Centre Hospitalier de L'Université de Montréal-Hotel Dieu; ; Department of Microbiology and Immunology, University of Montreal;
Cécile L
CL
Tremblay
Jean-Guy
JG
Baril
David
D
Fletcher
Donald
D
Kilby
Paul
P
Macpherson
Stephen D
SD
Shafran
Mark W
MW
Tyndall
Antiretroviral therapy; CD4 cell count; Complications of treatment; HIV infection; Patient readiness; When to start treatments