Treatment strategies for HIV infection

Treatment of HIV infection has improved markedly over the last 15 years with estimated life expectancy now near normal if infection is diagnosed early. HIV is now managed as a long-term chronic condition. Antiretroviral therapy (ART) suppresses the replication of HIV. Treatment success is defined as maintaining plasma viral load at undetectable levels, which enables reconstitution of the immune system.When to start ART in therapy-naive patients remains uncertain. All guidelines recommend starting when the CD4 lymphocyte count is at or lower than 350 cells/μl but differ in their recommendations at higher CD4 counts. ART also markedly reduces the risk of onward HIV transmission, and this may be the primary reason to start treatment in some individuals.Standard ART regimens contain a combination of two nucleoside reverse transcriptase inhibitors plus a third agent from a different class, such as protease inhibitor. Novel strategies to help reduce long-term drug toxicity and simplify regimens are being assessed in randomized trials. The main determinant of treatment success is the ability of patients to adhere to therapy and provision of adherence support is essential.Interest in research towards a HIV cure has increased and several approaches to providing a functional or sterilizing cure are being explored.