AEGiS-Glasgow [PL1.1] Antiretroviral treatment: what to start?

Seventh International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 14-17 November 2004

[PL1.1] Antiretroviral treatment: what to start?

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL1.1

Roy M. Gulick
Weill Medical College of Cornell University, New York, USA

Antiretroviral therapy suppresses HIV RNA levels, improves CD4 cell counts and immune function, and decreases HIV-related morbidity and mortality. However, antiretroviral therapy requires strict adherence, may cause short- and long-term toxicities, and, in the setting of virologic failure, selects for drug-resistant viral strains. Currently, there are 20 antiretroviral drugs approved for the treatment of HIV infection in 4 mechanistic classes: (1) nucleoside/tide analogue reverse transcriptase inhibitors (NRTI); (2) non-nucleoside analogue reverse transcriptase inhibitors (NNRTI); (3) protease inhibitors (PI); and (4) entry inhibitors. Current treatment guidelines recommend starting therapy with 2 nucleoside analogues combined with either an NNRTI or PI(s). Alternative initial therapy regimens include: 3 or 4 NRTIs, a 4-drug regimen of 3 NRTIs + an NNRTI, an NRTI-sparing regimen of an NNRTI + PI(s), and a triple-class regimen of NRTI(s) + NNRTI + PI(s). Initial treatment regimens should be simple, convenient, non-toxic, potent, durable, and preserve future treatment options. With that goal, a number of improvements have been made to current antiretroviral drug regimens. In addition, clinical trials with regimens incorporating newer antiretroviral drugs provide head-to-head comparisons with standard-of-care regimens. Some initial therapy regimens have demonstrated HIV RNA suppression rates exceeding 70-80% for up to 1-4 years. In addition, documentation of both increasing rates of drug resistance in untreated HIV-infected individuals and an increased risk for virologic failure on initial treatment regimens in this group supports routine baseline resistance testing in some groups of patients. Current options and management strategies for the initial treatment of HIV infection continue to evolve and it is critical to interpret and incorporate newer data into the current standard of care.

SESSION 1: TREATMENT STRATEGIES

2004-11-14
PL1.1

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