Abstract
PURPOSE OF REVIEW: The review reflects on opportunities and challenges for HIV treatment optimization for the next 5 years. RECENT FINDINGS: Considering all currently available options, the fixed-dose combination of tenofovir + lamivudine (or emtricitabine) + efavirenz is considered as the best option for first-line treatment for the short to medium term. Second-line therapy will likely continue to be comprised of a boosted protease inhibitor in combination with two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), with potential for combining with integrase inhibitors. For children, there is potential for simplification and harmonization with adult antiretroviral regimens. First-line therapy for children younger than 3 years of age may be best delivered using two nucleoside reverse transcriptase inhibitors (NRTIs) and a boosted protease inhibitor; above 3 years of age, the standard of care is two NRTIs and a non-nucleoside reverse transcriptase inhibitor (NNRTI) as recommended for adults. Important research questions include the dosing and safety of new antiretroviral agents and formulations, particularly once-daily fixed-dose combinations, the role of integrase inhibitors and the optimal second-line regimen for NNRTI-exposed children who fail protease inhibitor-containing first-line regimens. SUMMARY: Treatment simplification is critical to further antiretroviral therapy scaling-up and support long-term retention in care. Future guidance should consider the broader benefits of earlier antiretroviral therapy initiation beyond potential AIDS mortality reduction, notably mitigation of short- and long-term HIV-associated comorbidities, reduction of HIV transmission, increased retention in care, and enhancing programme simplification.
Original language | English (US) |
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Pages (from-to) | 591-599 |
Number of pages | 9 |
Journal | Current opinion in HIV and AIDS |
Volume | 8 |
Issue number | 6 |
DOIs | |
State | Published - Nov 1 2013 |
Keywords
- antiretroviral therapy
- fixed-dose combination
- integrase inhibitors
- regimen simplification
ASJC Scopus subject areas
- Immunology
- Hematology
- Oncology
- Oncology(nursing)
- Infectious Diseases
- Virology