Phillips, E. (2013) Antiretroviral therapy. Internal Medicine Journal, 43 . pp. 11-12.
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Management of the HIV patient has evolved considerably since the first antiretroviral drug, zidovudine was approved over 25 years ago. Improved potency of regimens in the mid-1990s when protease inhibitor therapy was introduced made it possible to suppress HIV viral replication in patients with a background of sequential NRTI monotherapy and resistance. The complexity of treatment, however, was very high at this time with many challenges related to high pill burden,adherence,drug toxicity and food and drug interactions. Significant advances have occurred over the last three decades and most notably over the last 5 years in accessibility of antiretro- viral therapy in the developing world. The implementation of more wide- spread and global treatment of HIV has and will have significant advantages including the prevention and reduction of morbidity and death related to opportunistic disease, and reduction in HIV transmission. More recently, evidence based medicine showing significant reduction in transmission and improved clinical outcomes in sero-discordant couples supports treatment as prevention and there is a universal mandate for test and treat strategies in an attempt to reduce the global burden of HIV. New drugs and drug classes have led to more treatment options and the ability to personalise antiretroviral treatment as well as improve the tolerability and simplicity of regimens in both antiretroviral treatment naïve and experienced patients. Observational studies have supported much earlier initiation of antiretro- viral therapy and a large randomized controlled trial is underway in an attempt to more directly assess the potential benefit of earlier therapy on reducing AIDS and non-AIDS morbidity and mortality. Further shifts have occurred more generally across national and international treatment guide- lines which now recommend initiation of treatment for all adults infected with HIV.
|Publication Type:||Journal Article|
|Murdoch Affiliation:||Institute for Immunology and Infectious Diseases|
|Copyright:||2013 The Authors|
|Notes:||Appears in: Abstracts for the RACP Future Directions in Health Congress 2013, 26-29 May 2013, Perth Convention and Exhibition Centre, Perth, Western Australia|
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