The use of combination antiretroviral therapy in HIV infected patients

OBJECTIVE: To review the published clinical trials of combination antiretro viral therapy, current guidelines about the use of combination antiretrovir al therapy, information regarding the impact of adherence on treatment effe ct, and the effects of combination antiretroviral therapy on morbidity and mortality. METHODS: A MEDLINE search (January 1986-March 1998) was performed to identi fy all relevant articles. Selected articles and abstracts from this time pe riod and references from these selections were included for rt view. DISCUSSION: Nucleoside analog monotherapy treatment of HIV infection is inf erior to treatment with multiple antiretroviral agents. With the availabili ty of new classes of medications (protease inhibitors, nonnucleoside revers e transcriptase inhibitors [NNRTIs], and new nucleoside analogs, combinatio n antiretroviral therapy is now more potent and more complex than ever. The use and effects of protease inhibitors in combination with nucleoside anal ogs has been well documented. The use of NNRTIs and combination protease in hibitor regimens are not as well documented but may prove to be at least as efficacious as single protease inhibitor-containing: regimens. Increases i n CD4+ cell counts of >100 cells/mm(3) and decreases in HIV RNA (viral load ) of >2 log are common with these medications, with antiretroviral naive pa tients being more likely to have substantial responses to therapy than expe rienced patients. CONCLUSIONS: Combination antiretroviral therapy in HIV-infected patients is now the standard of care. Combination antiretroviral regimens have been sh own to reduce, at least temporarily, the morbidity and mortality associated with HIV infection and AIDS. However, these regimens are quite complex for patients to adhere to successfully. While the true long-term effects of co mbination antiretroviral therapy are unknown, their current effects on the HIV epidemic are unquestionable.