Purpose of review: The treatment of HIV infection has been transformed by the introduction of highly active antiretroviral therapy. For patients who respond and can tolerate lifelong therapy, HIV infection may become a chronic disease requiring long-term ambulatory care follow-up. The current management of antiretrovirals is increasingly complex because of the large number of agents, wide spectrum of toxicities, adherence issues, and drug interactions. This review summarizes the currently available agents, recommended and alternative combinations, commonly encountered adverse events, and viral resistance issues.
Recent findings: Twenty antiretroviral medications are commercially available in the United States. Six new agents have been introduced since 2000, including one drug in a novel class of HIV fusion inhibitors. The adverse effects of antiretrovirals are well characterized and include lactic acidosis related to nucleoside reverse transcription inhibitors; metabolic and body habitus changes, primarily attributed to protease inhibitors; and concern about the long-term vascular consequences of elevated lipids and insulin resistance associated with treatment. The recommended antiretroviral therapy by an expert panel as of October 2004 is summarized.
Summary: The benefits of antiretroviral therapy are clear: reduced morbidity and mortality related to advanced HIV infection. Managing antiretroviral therapy, along with their adverse effects and drug interactions, is complex. Modern treatment mandates a thorough understanding of the agents. Consultation with an HIV-experienced clinician should be considered in most circumstances.