M.D. Dr. Joe Eron from the University of North Carolina, Chapel Hill, began the discussion of antiretroviral therapy by reviewing our current understanding of the virology of HIV infection.
Viral replication is a dynamic process, with billions of virions being produced per day.
The destruction of CD4 cells is directly linked with HIV replication and viral production. Those CD4 cells that do regenerate with effective antiretroviral therapy tend to be the cells that still exist, and are preferentially memory cells. When patients with advanced disease who have lost their naive CD4 cells are treated with antiretroviral therapy, the rise in absolute CD4 cell number may not reflect true restoration of immune function. Drug levels must be high enough to maintain constant inhibition of replication, which requires an understanding of drug interactions between antiretroviral agents. Successful therapy with highly suppressive regimens also involves strict adherence to treatment regimens.