Trends in the treatment of HIV infection

ABSTRACT

During the last decade several advances in understanding and management of human immunodeficiency virus [HIV] have resulted in optimism among clinicians and hope for patients. Research into areas of viral pathogenesis has made a direct impact on the clinical management of HIV-infected patients and has led to the development of new and more potent antiviral agents, regimens, and approaches to antiretroviral therapy [ART]. These highly active antiretroviral therapies [HAART] have dramatically altered the natural progression of infection and significantly improved the quality of life for many HIV-infected patients[1]. As a result there has been a substantial decline in reported number of AIDS-related opportunistic infections and deaths[2,3]. Despite these remarkable advances, several concerns should be addressed. Although many will benefit from new and potent regimens, up to 50% of patients show treatment failure[4], and approximately 40% change therapeutic regimens during the first year because of drug-related adverse events[5]. The development of drug resistance, long-term toxicities, patient compliance, the management of HAART failures, and the method to control and prevent the spread of HIV are major challenges. Hope for a cure for HIV infection was dampened by the discovery of a latent form of the virus that persists within the resting CD4 cells[6], perhaps as a result of survival advantage to T- cell from anti HIVgenes[7]