Using HAART to decrease perioperative HIV-1 transmission risk

Abstract

Thank you for your valuable comment in which you stated that by using protease inhibitors, the remaining virions will theoretically be noninfectious. The amount of infectious virions is crucial but difficult to determine in daily clinical practice. Lowering the absolute viral load and measuring this by routine assay offers a more graspable result. Therefore, we advocate the use of an integrase inhibitor to achieve a rapid decline in viral load. Combining this integrase inhibitor with a protease inhibitor instead of a nonnucleoside reverse transcriptase inhibitor offers the best of both worlds. You mentioned that both efavirenz and raltegravir have a relatively low genetic barrier. We are not concerned about drug resistance in compliant treatment-naive patients using raltegravir for this purpose. Initiating antiretroviral therapy in a clinical setting offers the advantage of directly observed therapy with intensive counselling by specialized nurses. Also in the outpatient setting, very little drug resistance and virologic failure has been described in treatment of naive patients using raltegravir [1]. Furthermore, we do not favour the long-term use of raltegravir in a first-line regimen.