Combination Anti-HIV Therapy: Questions and Answers

Abstract

It seems clear, given the ability of the HIV virus to produce variation in its structure, it’s presently deeply imbedded nature in our population, and its chronic asymptomatic carriage, this virus is not going to be durably impacted upon by any single modality or type of individual agent. Instead, we must combine a number of approaches to control it within a given patient and in society as a whole. Combination therapy includes intelligent sequencing of drugs in the individual as well as concomitant administration. The principles covering this approach can be taken from control strategies with other chronic diseases (tuberculosis or cancers) as well as the special possibilities that evolve from the nature of this viral infection and our host responses to it. Insights in pathogenesis coming from the study of untreated and treated patients must govern rational selection of therapy. At present, only CD4⁺ T cell level governs drug selection, whereas we must move to studies of an individual’s virus and more details of the immune system responses in order to select the most appropriate immediate and longterm therapy.