HAART roll‐out in the new fiscal and economic environment

Abstract

There are 27 approved antiretroviral drugs and combinations of these drugs clearly change the natural history of HIV infection, dramatically decreasing HIV‐related morbidity and mortality and promoting healthy survival. Despite the proven benefits, we continue to consider basic strategic questions about antiretroviral therapy: When should we start ART? What regimen to start? When should we change ART? What ART regimen should we change to?Also, despite the benefits of treatment, some antiretroviral regimens may be inconvenient, toxic, and/or have suboptimal antiretroviral activity, particularly against drug‐resistant viruses. Thus, newer compounds are needed that continue to improve convenience and tolerability, reduce toxicity, and improve antiretroviral activity, particularly against drug‐resistant viruses. Additionally, new drugs may better penetrate tissue reservoirs (e.g. genital tract, central nervous system) or exploit new targets with new mechanisms of action.There are a number of HIV drugs in development currently. These include a new pharmacokinetic “boosting” agent and newer antiretroviral agents in a number of existing classes, including new nucleoside reverse transcriptase inhibitors, non‐nucleoside reverse transcriptase inhibitors, protease inhibitors, entry inhibitors, and integrase inhibitors. In addition there are drugs with new mechanisms of action in development, including the CD4 attachment inhibitors. The clinical use of the newer agents will depend on the results of clinical trials, and the timeline for development and availability.