Successful HIV treatment: lessons learned

To review current insights concerning treatment of human immunodeficiency virus (HIV).

The range of antiretroviral agents available for treating patients who have HIV/AIDS (acquired immunodeficiency syndrome) has expanded to 20 medications since the first, zidovudine, was approved in 1987. While the exact choice of drugs to use in treatment must be tailored to the patient, depending on safety and tolerance, the ultimate goal is durable suppression of the HIV virus. Highly active antiretroviral treatment (HAART) is the current standard of care and involves treating the patient with a combination of antiretrovirals. First-line regimens usually contain a combination of 2 nucleoside reverse transcriptase inhibitors plus either one nonnucleoside or protease inhibitor. Differences in side effects have become more important than differences in efficacy in determining the choice of the initial antiretroviral regimen. To prevent the development of viral resistance to treatment, it is essential to begin treatment with all medications simultaneously, rather than sequentially. If the initial HAART regimen fails, more complex regimens that involve adding at least 2 new antiretrovirals can often reestablish control, even in patients with extensive pretreatment and in whom there was the development of viral resistance.

For patients with HIV/AIDS embarking on treatment today, the durability of HIV suppression in optimal regimens suggests that a normal lifespan is now a realistic outcome of HIV treatment.