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Early Versus Delayed Antiretroviral Therapy in Patients with HIV Infectionat

A Review of the Current Guidelines from an Immunological Perspective

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Abstract

The development and implementation of highly active antiretroviral therapy (HAART) for the treatment of the human immunodeficiency virus has revolutionised the care of patients with this disease. Despite the positive impact that antiretroviral therapy has had on the lives of individuals with HIV infection, the adverse effects, potential long-term toxicities, complexity of regimens, development of drug resistance and cost have made decisions about when to initiate HAART difficult. The benefits and risks of antiretroviral therapy vary considerably among patients at different stages of disease, mainly as a result of the irreversible destruction of the immune system that occurs as HIV infection progresses.

In acute HIV infection, the primary aim of treatment is preservation and reconstitution of HIV-specific immune function. In symptomatic or late-stage disease, the goal is control of viral replication with resulting improvement in non-HIV-specific immunity, which leads to decreased morbidity and increased survival. The most controversial decision involves when to start therapy in persons with asymptomatic chronic HIV, where the benefits are less well established and may be outweighed by the drawbacks, depending on the individual patient.

In all patients, the advantages and disadvantages must be considered carefully, and the readiness and ability of the individual to adhere to a complex multidrug regimen needs to be assessed before the initiation of therapy.

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Notes

  1. The cost to the patient at Brigham and Women’s Hospital (BWH) outpatient pharmacy, Boston, MA, US, averaged, at wholesale price, $US1217 per month. Personal communication with BWH pharmacy, 2002 Feb 20.

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Acknowledgements

Dr Eric Rosenberg was supported by NIH RO1 AI40873 during the writing of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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  1. Partners AIDS Research Center, Boston, Massachusetts, USA

    Anna R. Thorner &  Eric S. Rosenberg

  2. Massachusetts General Hospital, 55 Fruit Street, GRJ 529, Boston, Massachusetts, 02114, USA

    Anna R. Thorner &  Eric S. Rosenberg

  3. Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Anna R. Thorner

  4. Harvard Medical School, Boston, Massachusetts, USA

    Anna R. Thorner &  Eric S. Rosenberg

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Thorner, A.R., Rosenberg, E.S. Early Versus Delayed Antiretroviral Therapy in Patients with HIV Infectionat. Drugs 63, 1325–1337 (2003). https://doi.org/10.2165/00003495-200363130-00001

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