[Dual or triple combination antiretrovirals?]

Area of Science:

• Immunology
• Virology
• Pharmacology

Background:

• Antiretroviral therapy (ART) has significantly reduced HIV morbidity and mortality.
• Despite ART, persistent systemic immune activation, inflammation, and endothelial dysfunction occur.
• These issues contribute to non-AIDS diseases manifesting a decade earlier in people with HIV.

Purpose of the Study:

• To review the principles of systemic immune activation in HIV patients on ART.
• To discuss the potential for immune regeneration and intervention strategies.
• To evaluate the emerging question of dual-drug ART regimens versus traditional three-drug regimens regarding inflammation control.

Main Methods:

• This is a review discussing existing literature and data.
• It analyzes the pathophysiology of persistent inflammation in HIV.
• It examines the potential benefits and unanswered questions of two-drug ART regimens.

Main Results:

• Current ART paradigms, while effective, do not fully normalize all biomarkers.
• Chronic inflammation and immune activation persist, leading to earlier onset of non-AIDS comorbidities.
• The efficacy of two-drug regimens in suppressing persistent inflammation is not yet established.

Conclusions:

• Dual-drug ART regimens offer potential for reduced drug burden and toxicity.
• Further robust data from large prospective studies are needed to confirm the efficacy of dual regimens.
• Addressing persistent inflammation is crucial for improving long-term health outcomes in people living with HIV.