Virtual Patient Reference Library
Antiretroviral Therapy
page 1
General Guidelines
Specific Guidelines
When to initiate
Which agents
Monitoring
Modifying
Adding new drugs
Lipodystrophy Syndrome

Table 1: Antiretroviral Drugs
Table 2: Factors Affecting Medication Adherence

last update February 2003
 General Guidelines
The following recommendations are based on our current understanding of the pathophysiology of HIV disease and the results of clinical trials. They reflect updated guidelines of US Department of Health and Human Services (DHHS) and the International AIDS Society USA Panel (see links below).
  • The primary goal of antiretroviral therapy should be "to keep the viral load as low as possible for as long as possible."
  • Maximal suppression of the virus makes it more difficult for resistance to develop.
  • Partial suppression results in the emergence of "quasi-species," which are pre-existing, resistant mutant strains in the viral population; these arise because of the rapid turnover of HIV and the many random errors made during replication.
  • Approximately two-thirds of patients on combination antiretroviral therapy have an undetectable viral load in response to initial treatment; second and subsequent attempts at viral suppression are less often successful.
  • Current antiretroviral drugs are not thought to be curative because of the persistence of HIV in latent CD4 lymphocytes and "sanctuary sites," which are regions of the body, such as the central nervous system and gonads, in which some agents do not penetrate well.
  • Combination antiretroviral therapy is now considered the standard of care for HIV infection.
  • Sixteen antiretroviral agents have been approved to date by the Food and Drug Administration.
  • Antiretroviral agents (Table 1) are classified by their mode of action against the virus into the following categories:
    1. nucleoside reverse transcriptase inhibitors (NRTIs)
    2. non-nucleoside reverse transcriptase inhibitors (NNRTIs)
    3. protease inhibitors (PIs)
  • Antiretroviral agents vary considerably in their dosing and frequency of administration; how they should be given (with food or when fasting); their side-effect profiles; and their potential interactions with other drugs.

DHHS HIV/AIDS Treatment Information Service

International AIDS Society

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