Continuing debate over HIV therapy initiation

Abstract

Initiation of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infection has changed the landscape of HIV/AIDS care. However, the potential for long-term complications from therapy has emerged, and the risk/benefit associated with usage now merits more extensive evaluation. As data from ongoing and future clinical trials continue to accumulate, individualization of therapy may be the appropriate option for HIV-infected individuals.

Assessing and achieving readiness to initiate HIV medication

“…Risks and benefits of early versus delayed therapy is continuously debated [15][16][17][18], but no clinical data has so far shown long-term advantages to initiating antiretroviral therapy at early disease stages, rather than later, in asymptomatic patients [3]. A return to the ''hit hard, hit early'' approach to HAART has, however, again become of current interest due to advances in therapy, which have provided new regimens that are less toxic, better tolerated and more effective [19].…”

Guidelines for the use of antiretroviral agents in pediatric HIV infection

“…The choice whether to start therapy early, while an individual is still asymptomatic, versus delaying therapy until clinical or immunologic symptoms appear, continues to generate considerable controversy among pediatric and adult HIV experts [102]. Some experts favor starting aggressive therapy in the early stages of HIV infection in the hope that early antiretroviral intervention will control viral replication prior to the onset of rapid genetic mutation and evolution into multiple quasispecies.…”

Recommendations in pediatric antiretroviral therapy

“…Controversy exists regarding the treatment of asymptomatic infants with normal immunologic status [46]. Many experts would treat all HIV-infected infants < 12 months of age, regardless of clinical or immunologic parameters.…”