HIV update: emerging clinical evidence and a review of recommendations for the use of highly active antiretroviral therapy.

PURPOSE: This supplement will focus on recent trial data concerning the efficacy of certain nucleoside reverse transcriptase inhibitor (NRTI)-based highly active antiretroviral therapy (HAART) regimens, the most recent guidelines from the Department of Health and Human Services (DHHS) for the timing of antiretroviral (ARV) therapy initiation, and recommended ARV drug classes for managing treatment-naïve patients with HIV.
SUMMARY: When choosing an initial regimen for the treatment of HIV, it is important to carefully consider therapeutic goals. These goals include choosing HAART that is likely to maximally suppress viral replication, maintain or restore immunologic function, improve quality of life, and reduce HIV-related morbidity and mortality. The evidence-based DHHS guidelines recommend HAART regimens that are non-nucleoside reverse transcriptase inhibitor (NNRTI)- or protease inhibitor (PI)-based. DHHS, however, does not recommend the use of triple-NRTI therapy for the initial treatment of HIV unless a preferred or alternative NNRTI- or PI-based regimen cannot be used. This recommendation concerning triple-NRTI therapy is supported by results from recent trials that demonstrated inferior outcomes with triple-NRTI-containing regimens compared with NNRTI- or PI-based HAART regimens. The timing for initiation of ARV therapy continues to change over time as the DHHS guidelines have evolved. Although the benefits of initiating ARV when CD4 cell count is < 200 cells/mm3 are well established, the use of early versus late initiation of ARV therapy in patients with CD4 cell counts > 200 cells/mm3 has its own benefits and drawbacks.
CONCLUSION: To successfully manage people with HIV, it is crucial to find a balance between ARV potency, tolerability, safety, and convenience while providing durable viral suppression.