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Long-term management of the HIV-infected patient - Tailoring highly active antiretroviral therapy to optimise therapeutic outcome
Journal article   Open access   Peer reviewed

Long-term management of the HIV-infected patient - Tailoring highly active antiretroviral therapy to optimise therapeutic outcome

E. Martínez and D. Nolan
European Infectious Diseases, Vol.2(2), pp.16-22
2008
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Abstract

The introduction of highly active antiretroviral therapy (HAART) regimens has dramatically changed the prognosis of HIV-infected patients, as reflected by the sustained declines in the incidence of opportunistic infection and AIDS-related mortality that have occurred over the last decade.1 For those HIV-infected patients who achieve CD4 cell counts in excess of 500 cells/mm3 on long-term HAART, life expectancy now approaches that of the general population.2 However, the transformation of HIV/AIDS into a chronic disease requiring continuous, lifelong treatment with potent antiretroviral drug combinations presents the clinician with new challenges. HAART regimens are subject to various limitations, including inconvenience of dosing, acute and chronic toxicity and drug interactions that have a negative impact on patient compliance and the ability to achieve adequate viraemic control. A major factor for the long-term management of HIV infection is how to minimise the evolution of antiretroviral drug resistance and prevent virological failure. All effective antiretroviral agents will select for drug-resistant virus, and this risk is substantially increased in the presence of persistent low-level viraemia.3 Uncontrolled HIV replication and immune activation raises not only the prospect of progression to AIDS but also an increased risk of non-AIDS-defining diseases, such as non-AIDS cancers4,5 and cardiovascular, renal and hepatic end-organ dysfunction.

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