Revisiting monotherapy: heresy or revised orthodoxy?

Area of Science:

• * Virology and Immunology
• * Infectious Diseases and Public Health

Background:

• * The advent of triple combination antiretroviral therapy in 1996 dramatically reduced AIDS mortality.
• * Previous single-drug HIV treatment (monotherapy) proved ineffective due to rapid development of drug-resistant virus.
• * Monotherapy is now considered an outdated and potentially harmful approach to HIV management.

Discussion:

• * The shift from monotherapy to combination therapy reflects advancements in understanding HIV viral dynamics and resistance.
• * While combination therapy is the established dogma, some long-term patients on dual-drug regimens may still benefit from their current treatment.
• * Current HIV treatment guidelines universally recommend potent combination antiretroviral therapy.

Key Insights:

• * Monotherapy's failure to prevent HIV drug resistance underscores the importance of combination therapy.
• * Combination antiretroviral therapy, particularly with two nucleoside reverse transcriptase inhibitors (NRTIs) plus a protease inhibitor (PI) or non-NRTI (NNRTI), is the current standard.
• * The evolution of HIV treatment highlights the critical role of sustained viral suppression and resistance prevention.

Outlook:

• * Continued research into optimizing combination antiretroviral therapy regimens for efficacy and reduced toxicity.
• * Exploring the long-term outcomes and potential for de-escalation in select patient populations on effective dual therapy.
• * Focus on adherence and access to combination therapy to further improve global HIV/AIDS outcomes.