Biology Reference
In-Depth Information
21
New Perspectives in Antiretroviral Therapy
of HIV Infection
Stefano Vella
Istituto Superiore di SanitÁ, Rome, Italy
INTRODUCTION
The introduction, in 1995±1996, of the concept of maximal suppression of
human immunode®ciency virus (HIV ) replication together with the availability
of potent antiretroviral combinations produced a dramatic impact on the nat-
ural history of HIV disease, with unprecedented changes in disease progression
and mortality in the United States and in western countries ( Palella et al., 1998;
Sendi et al., 1999). In this part of the world, despite the unsuccessful attempts to
eradicate HIV infection from an infected individual (Finzi et al., 1999), at least
a ®rst important goal seems to have been obtained: possibility of turning HIV-1
infection from an inevitably fatal disease into a chronic condition, potentially
manageable over the course of decades.
However, despite impressive progress, much work remains to be done to
reach this target. Even with the most potent regimens available today, a signif-
icant proportion of patients fail to have a complete virological response after
their ®rst-line treatment. This population is at high risk to become less respon-
sive to subsequent antiretroviral regimens because of development of HIV resis-
tance to the antiretroviral drugs in their regimen. Moreover, incomplete response
rate and limited durability of the response are not the only shortcomings of the
current regimens. Other problems include complexity of pharmacokinetic inter-
actions with other drugs, burden of pills, and constraints in timing of adminis-
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