Antiretroviral therapy for HIV infection. A knowledge-based approach to drug selection and use

Drugs
G MoyleJ Gatell

Abstract

In the absence of evidence that eradication of HIV from an infected individual is feasible, the established goal of antiretroviral therapy is to reduce viral load to as low as possible for as long as possible. Achieving this with the currently available antiretroviral agents involves appropriate selection of components of combination regimens to obtain an optimal antiviral response. In addition, consideration of a plan for a salvage or second-line regimen is required if initial therapy fails to achieve an optimal response or should loss of virological control occur despite effective initial therapy. Such a planned approach, based on consideration of the likely modes of therapeutic failure (viral resistance, cellular resistance, toxicity) could be called rational sequencing. Choice of therapy should never involve compromise in terms of activity. However, the choice of drug should also be guided by tolerability profiles and considerations of coverage of the widest range of infected cells, compartmental penetration, pharmacokinetic interactions and, importantly, the ability of an agent or combination to limit future therapeutic options through selection of cross-resistant virus. Available clinical end-point data clearly indicate t...Continue Reading

Citations

Oct 24, 2001·HIV Clinical Trials·R ManfrediF Chiodo
Oct 13, 2006·Current Opinion in Infectious Diseases·G Moyle
May 23, 2007·Expert Opinion on Pharmacotherapy·Franco Maggiolo
Jun 8, 2001·Journal of Acquired Immune Deficiency Syndromes : JAIDS·P PezzottiUNKNOWN Italian Seroconversion Study
Jul 18, 2003·Current Infectious Disease Reports·Ferdinand W.N.M. Wit, Peter Reiss
Jul 5, 2005·Expert Opinion on Investigational Drugs·G J Moyle
Jan 1, 1999·International Journal of Psychiatry in Clinical Practice·A GonzalezI Everall
Feb 28, 2001·Journal of Clinical Pharmacology·L L von MoltkeR I Shader
Jun 6, 2000·Advanced Drug Delivery Reviews·G C Williams, P J Sinko

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