Recent advances in antiretroviral therapy in HIV infection.

The care of the human immunodeficiency virus (HIV)-infected patient has changed dramatically in the last few years. Potent new antiretroviral drugs combined with updated treatment strategies have now achieved efficient inhibition of HIV replication in most patients. Classes of drugs include both nucleoside and non-nucleoside inhibitors of the viral enzyme reverse transcriptase (RT) and inhibitors of the viral protease and integrase enzymes. As yet immune-based therapies have had little, if any, impact. However, it is clear that the eradication of HIV is not achievable with existing anti-HIV drugs and in spite of the major advances there remains many challenges in the clinical management of HIV-infected individuals. A major drawback of highly active antiretroviral therapy (HAART) is the selection of resistant mutants under suboptimal dosage, in advanced stages of disease or after pretreatment with mono- or double-combination regimens. Monitoring of antiretroviral therapy is achieved by measurement of viral load using nucleic acid amplification techniques. Recommendations for antiretroviral therapy and monitoring are evolving constantly due to the rapid progress in the development of active compounds and new insights into HIV pathogenesis.