Optimization and simplification of antiretroviral therapy for adults and children

Nathan Ford, Charles Flexner, Stefano Vella, David Ripin, Marco Vitoria

Research output: Contribution to journalReview articlepeer-review

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 languageEnglish (US)
Pages (from-to)591-599
Number of pages9
JournalCurrent opinion in HIV and AIDS
Volume8
Issue number6
DOIs
StatePublished - 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

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