Improvements in antiretroviral therapy outcomes over calendar time

The introduction of combination antiretroviral therapy (cART) led to substantial reductions in HIV-associated morbidity and mortality. However, the regimens in the early cART era were cumbersome and toxic. The introduction of new ART agents, fixed-dose combinations and novel strategies for cART delivery such as ritonavir 'boosting' of HIV-protease inhibitors have led to a perception of improvements in the tolerability and durability of contemporary cART regimens. It is in turn assumed that these developments have led to improved outcomes in the latter era of cART.

Both cohort studies and randomized clinical trials suggest improvements in cART outcomes over calendar time. Key associated factors include reduced pill burden and dosing interval and improved tolerability and reduced toxicity of newer ART. A critical appreciation of the association between ART adherence and regimen durability has been important. Cohorts in recent times have included more patients who are completely ART-naïve at therapy initiation.

The prognosis of HIV infection in developed countries is in the order of 40 years after cART initiation. An appreciation of the factors associated with long-term control of HIV viraemia is essential for the optimal management of the HIV-infected individual in contemporary practice.