THE CHALLENGES OF HAART

The use of highly active antiretroviral therapy (HAART) for HIV infection has been able to suppress viral replication and preserve immune function significantly enough to decrease the morbidity and mortality associated with this condition. In many settings, HIV infection can be viewed as a chronic and manageable disease, albeit one that requires lifelong treatment with complex drug combinations.

The prospect of long-term exposure to HAART has presented many challenges (Figure 1). The remarkable therapeutic success that has been achieved is at the expense of long-term adherence. This is because patients bear the burden of managing complex regimens, heavy pill burdens and treatment-limiting toxicities. Protracted courses of HAART compound the problems of adherence and leave the patient vulnerable to treatment failure and the development of drug-resistant variants. Other key issues relating to lifelong therapy include issues such as when to initiate therapy and management of adverse events.

Today, it is becoming increasingly clear that treatment for HIV infection must strike a balance between the benefits of therapy, which are proven, and its toxicities. The goal before us is to now design less complicated and more tolerable treatments that will foster improved adherence, allowing patients to reap the full benefits that HAART can provide.

Thus, the emerging standard of care in antiretroviral therapy today is to develop newer, simpler and safer treatment options.