Treatment strategies

There are many factors to consider when choosing an effective antiretroviral regimen, including:

• Host factors: viral load, CD4 cell count, overall health, genetics, adherence abilities, and treatment history
• Viral factors: tropism and drug resistance
• Antiretroviral: side-effects, dosing, drug interactions/pharmacokinetics, drug cost/availability
• Other: opportunistic infections and other HIV- and non-HIV-related clinical events.

The goal of antiretroviral therapy is to durably suppress viral load to an undetectable level in order to restore and maintain immune function, as indicated by a rising CD4 cell count; extend disease-free length of survival; and limit transmission.

Using current antiretroviral drugs, HIV cannot be completely eradicated from the body and treatment will probably need to be life-long. But individuals who are already using highly active antiretroviral therapy (HAART) also have options to consider, including switching to simpler regimens that are able to provide more potent viral suppression, fewer side-effects, improved convenience, or lower cost. With more than 20 antiretroviral drugs approved for marketing or available through expanded access programmes, there are now new choices for constructing effective HAART regimens.

Researchers have explored various treatment strategies, including regimen simplification, induction and maintenance therapy, and switching between regimens that are non-nucleotide reverse transcriptase inhibitor (NNRTI)-containing or protease inhibitor (PI)-based.

One therapy that is not recommended is a structured treatment interruption, unless in the context of a clinical trial. Otherwise, interrupting therapy may cause rapid viral rebound, CD4 cell loss, and clinical progression. For further information on switching regimens, see Changing HIV treatment.