Related Experiment Video
Updated: Jul 15, 2026
10:20
Interview: HIV-1 Proviral DNA Excision Using an Evolved Recombinase
Published on: June 16, 2008
Hit HIV-1 hard, but only when necessary
1Treatment Action Group, New York, NY 10001, USA. markharrington@aol.com
Lancet (London, England)
|July 21, 2000
Summary
Starting combination antiretroviral therapy for HIV-1 infection when CD4 counts drop below 350 cells/microL balances benefits against risks. This approach helps delay or prevent immune damage, AIDS, and death in HIV-1 patients.
Area of Science:
- Immunology
- Virology
- Infectious Diseases
Background:
- Combination antiretroviral therapy (cART) is crucial for managing HIV-1 infection.
- The optimal timing for initiating cART remains a critical clinical question due to potential toxicities and resistance.
- HIV-1 infection presents unique challenges: no cure, drug toxicities, and risk of multidrug resistance.
Purpose of the Study:
- To discuss the data justifying a balanced approach to initiating cART for HIV-1.
- To evaluate the feasibility of randomized controlled trials (RCTs) to determine optimal cART initiation timing.
- To balance the benefits of early treatment against the risks of cumulative side-effects and resistance.
Main Methods:
- Review of randomized controlled trial data on cART efficacy.
- Analysis of risks and benefits associated with different treatment initiation thresholds.
- Discussion of clinical monitoring parameters: CD4-cell counts and viral load.
Main Results:
- cART benefits individuals with CD4-cell counts below 350 cells/microL.
- Careful monitoring allows for delayed initiation, potentially preventing immune damage and disease progression.
- Starting therapy too early risks outweighing benefits due to side-effects and resistance; starting too late increases mortality.
Conclusions:
- Initiating cART when CD4 counts are below 350 cells/microL, with careful monitoring, is a justifiable approach.
- This strategy aims to delay or prevent AIDS and death while minimizing cumulative drug toxicity and resistance.
- Further RCTs are needed to refine optimal treatment initiation strategies for HIV-1 infection.
Related Concept Videos
01:10Retrovirus Life Cycles
Retroviruses have a single-stranded RNA genome that undergoes a special form of replication. Once the retrovirus has entered the host cell, an enzyme called reverse transcriptase synthesizes double-stranded DNA from the retroviral RNA genome. This DNA copy of the genome is then integrated into the host’s genome inside the nucleus via an enzyme called integrase. Consequently, the retroviral genome is transcribed into RNA whenever the host’s genome is transcribed, allowing the retrovirus to...
01:26Sexually Transmitted Infections
Sexually transmitted infections (STIs) are diseases transmitted primarily through unsafe sexual interactions. Bacteria, viruses, or parasites cause them and can result in severe health complications if untreated.ChlamydiaThe bacterium Chlamydia trachomatis is responsible for the disease Chlamydia, the most common STI in the United States. This peculiar pathogen requires human cells to reproduce, residing intracellularly. The initial infection often goes unnoticed because it typically does not...
01:26Size and Structure of Viral Genomes
Viral genomes exhibit remarkable diversity in size, structure, and composition, influencing their replication strategies and interactions with host cells. These genomes consist of either DNA or RNA and may be linear or circular. Additionally, they can be single-stranded or double-stranded, with each configuration affecting how the virus propagates within a host. RNA viruses, for instance, generally have smaller genomes than DNA viruses, a factor that contributes to their high mutation rates and...
01:27Cryptococcal Meningitis
Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
01:22Antiviral Nucleoside Inhibitors
Antiviral Nucleoside InhibitorsAntiviral nucleoside inhibitors are structural analogs of natural nucleosides that interfere with viral DNA or RNA synthesis. These compounds selectively target viral polymerases due to their resemblance to host nucleosides, thereby disrupting viral genome replication.Mechanism of Acyclovir ActionAcyclovir is a guanosine analog with a three-carbon acyclic side chain. It selectively targets herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2),...
01:19Inhibitors of Virion Maturation and Assembly
As part of their replication cycle, certain viruses synthesize long precursor proteins called polyproteins within infected host cells. In human immunodeficiency virus (HIV), two major polyproteins are produced: Gag and Gag-Pol. The Gag polyprotein supplies the structural components of the virus, while Gag-Pol includes essential viral enzymes such as reverse transcriptase, integrase, and protease. After synthesis, these polyproteins move to the host cell membrane, where they assemble into an...