Modern anti-HIV therapy

Highly active antiretroviral therapies (HAART), usually consisting of two n ucleoside reverse transcriptase inhibitors (NRTI) plus an HIV protease inhi bitor (PI), have been widely used since 1996. They produce durable suppress ion of viral replication with undetectable plasma levels of HIV-RNA in more than half of patients. Immunity recovers, and morbidity and mortality fall by more than 80% [1, 2]. Treatment was thought to be particularly effectiv e when started early; therefore, HAART was recommended for essentially all HIV-infected persons willing to commit themselves to lifelong therapy [3, 4 ]. Besides these successes however; HAART also produces problems. HIV is not e radicated by present-day drugs, and patients often cannot comply with long- term combination treatment [5, 6]. Moreover; HAART causes unexpected and il l-understood side effects [7]. The dogma of earliest possible treatment has therefore come under attack. Ten principles governing anti-retroviral treatment are summerised in Table I. Starting and maintaining HAART is complex. Within the last few years, th e numbers of antiretrovirals, their known and potential interactions with e ach other and with non-HIV drugs, and the list of their side effects have a ll increased exponentially. As a mile a physician specialising in HIV care should be consulted whenever HAART is started ol changed. It is his task to ensure that the treatment chosen is optimal for the particular patient.