Achieving undetectable viral load is the primary goal of treatment.1 The DHHS Guidelines strongly recommend starting treatment-naive patients with a dual NRTI in combination with an INSTI to achieve virologic suppression.1

As a result of advancements in HIV medicines, the number of patients aging with HIV has increased.1 Therefore, considering factors beyond the efficacy of treatments when selecting a regimen may be beneficial to patients.1 A more comprehensive approach to treatment selection can help account for evolving patient needs and impact long-term treatment outcomes.1

Medical comprehensive HIV therapy

Comprehensive HIV therapy can address both the immediate and longer-term needs of patients

Chart of comprehensive HIV therapy attributes

For more information about the long-term needs of patients living with HIV, explore educational resources.

Factors to consider

FACTORS TO CONSIDER

There are various factors to consider when choosing a comprehensive HIV therapy for patients that can help support them throughout different parts of their life.1 A regimen should be chosen based on individual patient considerations as well as characteristics of the regimen.1

PATIENT CONSIDERATIONS1

  • Concomitant medications
  • Comorbidities and coinfections (especially in older patients)
  • Prior side effects
  • Baseline resistance
  • Inconsistent access to medication
  • Access/coverage
  • Adherence potential today and over the course of the patient's lifetime

TREATMENT CONSIDERATIONS1

  • Virologic efficacy
  • Potential short- or long-term side effects
  • Pill size/burden
  • Dosing frequency
  • Drug-drug interactions and potential short- or long-term toxicities
  • Convenience
  • Food effects
  • Ability to use regardless of baseline viral load and CD4 count
Target key treatment goals

Key Treatment Goals

A comprehensive approach to HIV treatment can help patients stay on the treatment course and meet their treatment goals.

Maximal and durable viral suppression1

  • According to DHHS Guidelines, any recommended HIV therapy should have demonstrated durable virologic efficacy data meeting noninferiority criteria in a large comparative clinical trial
  • Durable viral suppression can be maintained with treatment that has a favorable resistance profile
  • Regimens with low genetic barriers to resistance are more likely to result in virologic failure

Preserves or improves immunologic function1-4

  • Damage to the immune system may occur early in the course of HIV infection
  • Suppressing viral load with antiretroviral therapy (ART) minimizes patients’ exposure to systemic HIV-related inflammation and immune activation

Reduction in HIV-associated morbidity and prolonged duration of survival1

  • The use of ART has significantly reduced HIV-associated morbidity and mortality

Prevention of transmission1

  • According to a modelling study, ART has the potential to positively affect HIV incidence at the population level, and to lower overall prevalence1,5

Patients on a high-potency antiretroviral regimen should be able to reach that treatment goal also. I think too, really, getting the patient to be on a regimen that actually adheres to their lifestyle, that actually fits into their daily activities so that they can remain adherent to their medications, which we know is a key to reaching virologic suppression. And, of course, that regimen being tolerable for the patient to take too."

–Derrick Butler, MD

You want to make sure that whatever regimen you develop for the patient is something that fits their lifestyle."

–Leandro Mena, MD

Watch a panel of HIV specialists discuss setting and achieving treatment goals.

REFERENCES:

  1. US Department of Health and Human Services. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. https://aidsinfo.nih.gov/contentfiles/adultandadolescentgl.pdf. Updated May 30, 2018. Accessed June 4, 2018.
  2. Sereti I, Krebs SJ, Phanuphak N, et al. Persistent, albeit reduced, chronic inflammation in persons starting antiretroviral therapy in acute HIV infection. Clin Infect Dis. 2017;64(2):124-131.
  3. Deeks SG, Tracy R, Douek DC. Systemic effects of inflammation on health during chronic HIV infection. Immunity. 2013;39(4):633-645.
  4. Deeks SG. HIV infection, inflammation, immunosenescence, and aging. Annu Rev Med. 2011;62:141-155.
  5. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48-57.