Strategies of Antiretroviral Therapy
Strategies of Antiretroviral Therapy
The decision to initiate antiretroviral therapy is one of the most critical junctures in the course of management of patients with HIV-1 infection, and the considerations involved regarding when to start treatment and with what to start must be individualized for each patient. Determining when to start includes considerations not only of disease stage but also of psychosocial issues, such as the patient's ability and willingness to begin treatment. Once the decision is made to start therapy, a regimen and treatment strategy that have the best chance to achieve maximal and durable suppression of viral replication for the particular patient must be chosen.
The decision to initiate antiretroviral therapy is one of the most critical junctures in the course of management of patients with HIV-1 infection. One must balance the proven benefits of potent therapy against the risks that have become increasingly apparent -- in particular, the potential for the emergence of drug resistance and long-term metabolic and possibly cardiovascular toxicities. Although this decision is often distilled into the 2 simple questions of "when to start" and "what to start with," this belies the true complexity of the situation.
The decision to initiate antiretroviral therapy is one of the most critical junctures in the course of management of patients with HIV-1 infection, and the considerations involved regarding when to start treatment and with what to start must be individualized for each patient. Determining when to start includes considerations not only of disease stage but also of psychosocial issues, such as the patient's ability and willingness to begin treatment. Once the decision is made to start therapy, a regimen and treatment strategy that have the best chance to achieve maximal and durable suppression of viral replication for the particular patient must be chosen.
The decision to initiate antiretroviral therapy is one of the most critical junctures in the course of management of patients with HIV-1 infection. One must balance the proven benefits of potent therapy against the risks that have become increasingly apparent -- in particular, the potential for the emergence of drug resistance and long-term metabolic and possibly cardiovascular toxicities. Although this decision is often distilled into the 2 simple questions of "when to start" and "what to start with," this belies the true complexity of the situation.