Abstract
Since the advent of highly active antiretroviral therapy (HAART), the treatment of human immunodeficiency virus (HIV) infection has become more potent and better tolerated. While the current treatment regimens still have limitations, they are more effective, more convenient, and less toxic than regimens used in the early HAART era, and new agents, formulations and strategies continue to be developed. Simplification of therapy is an option for many patients currently being treated with antiretroviral therapy (ART). The main goals are to reduce pill burden, improve quality of life and enhance medication adherence, while minimizing short- and long-term toxicities, reducing the risk of virologic failure and maximizing cost-effectiveness. ART simplification strategies that are currently used or are under study include the use of once-daily regimens, less toxic drugs, fixed-dose coformulations and induction-maintenance approaches. Improved adherence and persistence have been observed with the adoption of some of these strategies. The role of regimen simplification has implications not only for individual patients, but also for health care policy. With increased interest in ART regimen simplification, it is critical to study not only implications for individual tolerability, toxicity, adherence, persistence and virologic efficacy, but also cost, scalability, and potential for dissemination and implementation, such that limited human and financial resources are optimally allocated for maximal efficiency, coverage and sustainability of global HIV/AIDS treatment.
Video abstract
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Acknowledgements
Jean Nachega is supported by The United States National Institutes for Allergy and Infectious Disease (NIAID-NIH), Division of AIDS (DAIDS): K23AI 068582-01; The US President’s Emergency Plan for AIDS Relief (PEPFAR) program through the Fogarty International Center (FIC)/NIH and Health Research Administration (HRSA) Grant Award: T84HA21652-01-00 for Medical Education Partnership Initiative (MEPI); The European Developing Countries Clinical Trial Partnership (EDCTP) Senior Fellowship Award: TA-08-40200-021 and the Wellcome Trust Southern Africa Consortium for Research Excellence (SACORE): WT087537MA. Michael Mugavero is supported by the NIH; P30AI27767, R24AI067039, K23MH082641, and R21AI087360. Michele Zeier receives partial support from PEPFAR program via the US Agency for International Development, (USAID) under Cooperative Agreement No. 674-A-00-08-00009-00. The views expressed in this publication do not necessarily reflect those of PEPFAR, USAID or WHO.
Disclosure
In the last 12 months, Dr Jean Nachega has received consulting fees or participated in scientific advisory boards for Gilead Sciences and/or Boehringer-Ingelheim and is a speaker bureau member for Glaxosmithkline and Gilead Sciences. Dr Michael Mugavero has received consulting fees for participation in scientific advisory boards from Bristol-Myers Squibb, Gilead Sciences and Merck & Co as well as research support from Bristol-Myers Squibb, Tibotec, Pfizer, and Definicare. Dr Joel Gallant has received consulting fees or participated in scientific advisory boards, data safety monitoring boards, or endpoint review committees for Bristol-Myers Squibb, Gilead Sciences, Merck and Company, Tibotec Therapeutics, and ViiV Healthcare. Johns Hopkins University has received research funding from Gilead Sciences for research conducted by Dr Joel Gallant.