The use of combination antiretroviral therapy in HIV-infected patients.

OBJECTIVE: To review the published clinical trials of combination antiretroviral therapy, current guidelines about the use of combination antiretroviral therapy, information regarding the impact of adherence on treatment effect, and the effects of combination antiretroviral therapy on morbidity and mortality.
METHODS: A MEDLINE search (January 1986-March 1998) was performed to identify all relevant articles. Selected articles and abstracts from this time period and references from these selections were included for review. DISCUSSION: Nucleoside analog monotherapy treatment of HIV infection is inferior to treatment with multiple antiretroviral agents. With the availability of new classes of medications (protease inhibitors, nonnucleoside reverse transcriptase inhibitors [NNRTIs], and new nucleoside analogs, combination antiretroviral therapy is now more potent and more complex than ever. The use and effects of protease inhibitors in combination with nucleoside analogs has been well documented. The use of NNRTIs and combination protease inhibitor regimens are not as well documented but may prove to be at least as efficacious as single protease inhibitor-containing regimens. Increases in CD4+ cell counts of >100 cells/mm3 and decreases in HIV RNA (viral load) of >2 log are common with these medications, with antiretroviral naive patients being more likely to have substantial responses to therapy than experienced patients.
CONCLUSIONS: Combination antiretroviral therapy in HIV-infected patients is now the standard of care. Combination antiretroviral regimens have been shown to reduce, at least temporarily, the morbidity and mortality associated with HIV infection and AIDS. However, these regimens are quite complex for patients to adhere to successfully. While the true long-term effects of combination antiretroviral therapy are unknown, their current effects on the HIV epidemic are unquestionable.