If We Can't Get What We Want, Can We Get What We Need? Optimizing Use of Antiretroviral Therapy in the Current Era
Authors: Jason V. Baker, Keith Henry
Journal: Annals of Internal Medicine (2011)

Editorials19 April 2011If We Can't Get What We Want, Can We Get What We Need? Optimizing Use of Antiretroviral Therapy in the Current EraJason V. Baker, MD, MS and Keith Henry, MDJason V. Baker, MD, MSFrom University of Minnesota School of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.Search for more papers by this author and Keith Henry, MDFrom University of Minnesota School of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-8-201104190-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Combination antiretroviral therapy (cART) has revolutionized HIV care over the past 15 years, converting a fatal disease into a treatable chronic condition. Despite this success, uncertainty remains regarding the optimal time to initiate cART. In 1998, the U.S. Department of Health and Human Services recommended an aggressive approach of starting cART at any CD4 cell count less than 0.500 × 109 cells/L (1). Concerns about drug toxicity and accumulating resistance mutations motivated the panel to subsequently lower the CD4 cell count threshold to 0.200 to 0.350 × 109 cells/L. Because of the improved short-term safety of currently regimens and the ...References1. Report of the NIH Panel to Define Principles of Therapy of HIV Infection. MMWR Recomm Rep. 1998;47 RR-5 1-41. [PMID: 9572120] MedlineGoogle Scholar2. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Washington, DC: U.S. Department of Health and Human Services; 2011:1-166. Google Scholar3. The HIV-CAUSAL Collaboration. When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries. 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Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356:1723-35. [PMID: 17460226] CrossrefMedlineGoogle Scholar11. Baker JV, Peng G, Rapkin J, Abrams DI, Silverberg MJ, MacArthur RD, et al; Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection. AIDS. 2008;22:841-8. [PMID: 18427202] CrossrefMedlineGoogle Scholar12. Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000;342:921-9. [PMID: 10738050] CrossrefMedlineGoogle Scholar13. Das M, Chu PL, Santos GM, Scheer S, Vittinghoff E, McFarland W, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS One. 2010;5:11068. [PMID: 20548786] CrossrefMedlineGoogle Scholar14. 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Accessed at www.sfexaminer.com/local/2011/01/syphilis-cases-hit-all-time-high on 15 March 2011. Google Scholar18. National Alliance of State & Territorial AIDS Directors. The ADAP Watch. Washington, DC: National Alliance of State and Territorial AIDS Directors; 2011. Google Scholar19. White House Office of National AIDS Policy. National HIV/AIDS Strategy. 2010. Accessed at aids.gov/federal-resources/policies/national-hiv-aids-strategy on 15 March 2011. Google Scholar20. Linas BP, Losina E, Rockwell A, Walensky RP, Cranston K, Freedberg KA. Improving outcomes in state AIDS drug assistance programs. J Acquir Immune Defic Syndr. 2009;51:513-21. [PMID: 19561518] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Minnesota School of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0561.Corresponding Author: Keith Henry, MD, HIV Program, Hennepin County Medical Center, 701 Park Avenue, MC O1, Minneapolis, MN 55415; e-mail, [email protected]com.Current Author Addresses: Drs. Baker and Henry: HIV Program, Hennepin County Medical Center, 701 Park Avenue, MC O1, Minneapolis, MN 55415. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoWhen to Initiate Combined Antiretroviral Therapy to Reduce Mortality and AIDS-Defining Illness in HIV-Infected Persons in Developed Countries Metrics Cited ByManifestaciones reumatológicas de la infección por el virus de la inmunodeficiencia humanaCurrent Challenges to the United States’ AIDS Drug Assistance Program and Possible Implications of the Affordable Care Act 19 April 2011Volume 154, Issue 8Page: 563-565KeywordsAIDSAntiretroviral therapyCohort studiesHIVHIV infectionsRisk managementToxicityViral load ePublished: 19 April 2011 Issue Published: 19 April 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...