New antiretroviral therapy and its role in HIV treatment in Asia

Non-nucleoside analog reverse transcriptase inhibitor (NNRTI)-based therapy including fixed-dose combinations (tenofovir/emtracitabine/efavirenz in the developed world, or stavudine or zidovudine/lamivudine/nevirapine in the developing world) has been used widely as preferred first line therapy. However, NNRTIs have a low genetic barrier to resistance which increases the chance of treatment failure in poorly adherent patients. Newer antiretroviral drugs, including etraverine, darunavir, maraviroc, and raltegavir, have demonstrated efficacy and safety in patients who have experienced at least two classes of antiretrovirals. With appropriate use of these new drugs, in combination with other active antiretroviral agents, the goal of suppression of viral load below 50 copies can be achieved.This article is a review of currently available and future new antiretroviral drugs for second line and salvage therapies in resource-limited settings.

Evidence-based strategies for preventing HIV transmission and the Thailand perspective

A wide range of HIV prevention strategies have been evaluated or are in late-stage clinical trials. These include male circumcision, microbicides, diagnosis and treatment of sexually transmitted diseases, barriers, pre-exposure and post-exposure sexual prophylaxis with antiretroviral drugs, and behavioral interventions. While condoms are widely available and highly effective if used consistently and correctly, they have not been the answer to the problem, with UNAIDS reporting that 2.7 million new HIV infections occur each year. Current behavioural prevention interventions have been associated with a decline in HIV prevalence in some settings but have yet to demonstrate a generalizable impact. Biomedical interventions, such as male circumcision, substitution therapy for injection drug users, management of sexually transmitted diseases, antiretroviral therapy, female barrier methods and topical microbicides offer promise, with many under investigation in clinical trials. However, no single biomedical or behavioral intervention is likely to be effective and the focus of research is switching to the investigation of combinations of strategies.This review examines proven biomedical methods of reducing HIV transmission, such as male circumcision, efforts which have failed (e.g. first generation microbicides) and strategies for the future, including pre-exposure prophylaxis and next generation microbicides. Behavioural interventions are the keys to any successful efforts to reduce HIV transmission. While such interventions may provide (short-term) changes in individual behavior, new strategies seek to effect behavioural change at a population level.