Open AccessChallenges in Initiating Antiretroviral Therapy in 2010
Author(s) -
Cécile Tremblay,
Jean-Guy Baril,
David F. Fletcher,
Donald Kilby,
Paul MacPherson,
Stephen D. Shafran,
Mark W. Tyndall
Publication year - 2010
Publication title -
the canadian journal of infectious diseases and medical microbiology/canadian journal of infectious diseases and medical microbiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.634
H-Index - 38
eISSN - 1918-1493
pISSN - 1712-9532
DOI - 10.1155/2010/165926
Subject(s) - medicine , protease inhibitor (pharmacology) , nucleoside reverse transcriptase inhibitor , antiretroviral therapy , reverse transcriptase , reverse transcriptase inhibitor , population , clinical trial , ritonavir , adverse effect , drug , infectivity , intensive care medicine , human immunodeficiency virus (hiv) , virology , pharmacology , immunology , viral load , virus , biology , rna , biochemistry , environmental health , gene
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 antiretroviral 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.