Antiretroviral therapy: research, rollout and resistance

Angie N Pinto,David A Cooper

doi:10.1071/ma14024

Abstract

Antiretroviral therapy has revolutionised the management of human immunodeficiency virus (HIV). Advances in research leading to the development of combination antiretroviral therapies (ARTs) have led to significant decreases in AIDS related morbidity and increases in life expectancy for individuals with access to treatment. The goal of ‘getting to zero : zeroAIDs relateddeaths’now iswithin reach.Globally nearly 10million people have access to ART; however, further rollout efforts are required to reach the 34million people livingwithHIVsustainablyover the longterm.Changing paradigms see a broader scope for ART with a push towards earlier initiation, and even pre-exposure prophylaxis, with public health goals of preventing new infections. In Australia, collaborative research efforts, bipartisan political will and subsidised medication costs have allowed around 13000 people to be maintained on antiretroviral therapy. Despite this, the challenges of continuous lifelong suppressive therapy remain, as currently there is no cure. Poor adherence can lead to disease progression and drug resistance, limiting future treatment options. Antiretroviral resistance in Australia appears to have been stable, but changing epidemiology and evolving viral subtypes may impact these rates. This article will reflect on the advances in antiretroviral research, rollout and resistance in our region.

Highlights

Available antiretroviral therapies (ARTs) targets five key pathways of the human immunodeficiency virus (HIV) life cycle
The release of protease inhibitors (PIs) in 1995 allowed dual class highly active antiretroviral therapy (HAART) that has transformed the management of HIV
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are an important part of the antiretroviral landscape, and are currently recommended as part of the preferred first line regimens for naïve patients[5]

Summary

Introduction

Available ART targets five key pathways of the HIV life cycle (see Figure 2). Australia has benefitted from early access and rollout of ART, and has one of the highest treatment rates in the world, with around 50–70% of those diagnosed receiving treatment, and 85–95% of these with a suppressed viral load (see Figure 1)[1]. In 1987, treatment was limited to monotherapy with a nucleoside reverse transcriptase inhibitor (NRTI) until the availability of dual NRTI therapy in 1992.

Results

Conclusion