Highlights of Antiretroviral Therapy for Adults and Adolescents Patients with HIV Infection in the Technological Era

Abstract

Significant advances in antiretroviral therapy have been made since the introduction of Zidovudine (AZT) in 1987 but in the “Technological Era” 36.7 million people are infected with HIV worldwide with a dramatic increase of adolescent and young (40%) of new HIV Infections. The news antiviral cocktails can reduce HIV in patients experienced, prolong survival, and prevent HIV transmission. In the Technological Era Combination Antiretroviral Therapy (cART) containing preferably three active drugs from two or more classes is required for sustained virologic suppression. Regimen selection is based on virologic efficacy, limited side effects, resistance test results, comorbid conditions, social status, and cost. With prolonged virologic suppression, improved clinical outcomes, and longer survival, patients will be exposed to antiretroviral agents for decades. Therefore, maximizing the safety and tolerability of cART is a high priority. Emergence of resistance and/or lack of tolerability in individual patients require availability of a range of treatment options. Development of new drugs is focused on improving safety (e.g. tenofovir alafenamide) and/or resistance profile (e.g. doravirine) within the existing drug classes, combination therapies with improved adherence (e.g. single-tablet regimens), novel mechanisms of action (e.g. attachment inhibitors, maturation inhibitors, broadly neutralizing antibodies), and treatment simplification with infrequent dosing (e.g. long-acting injectables). In parallel with cART innovations, research and development efforts focused on agents that target persistent HIV reservoirs may lead to prolonged drug-free remission and HIV cure.