Challenges of Antiretroviral Therapy

Challenges of Antiretroviral Therapy

Despite the effects that antiretrovirals have on AIDS, they do not cure the disease. Most people remain infected for life, no matter how effectively antiretroviral drugs keep the viral load down and boost the immune system.

Antiretrovirals do not prevent HIV transmission. In spite of potent antiretroviral combinations, people who are infected with HIV can still transmit the virus. They must practice safer sex and refrain from certain behaviors to avoid infecting others.

Several antiretrovirals must be taken together to be effective. Using antiretrovirals in various combinations delays resistance and enhances the potency of the drugs. Resistance, which can take weeks to months to evolve, occurs when a mutation in the structure of the virus enables it to evade the action of the drugs. Once HIV becomes resistant to a drug, the drug is no longer effective.

Patients who take antiretrovirals should be aware that long-term effects of taking the drugs every day for many years are not yet known. Long-term health complications may include many problems, such as premature cardiovascular disease.

Antiretroviral therapy poses a complicated challenge to patients and health care practitioners for the following reasons:

• Patients must adhere to a strict regimen, which usually means they must organize their lives around taking the drugs.
• Treatment requires an individualized combination of drugs.
• Therapy requires life-long monitoring of HIV resistance and drug efficacy.
• HIV can still develop resistance.
• Drug-drug interactions can have severe, sometimes deadly, adverse consequences.

Physicians and patients must weigh potential costs and benefits of antiretroviral therapy, as well as the risk for disease progression (i.e., the risk for developing AIDS or AIDS related complications). Decisions regarding if and when to start therapy, which drugs to choose, and when to change drugs are based on each patient's individual circumstances and on detailed knowledge of the patient's medication history.