Current ARTs, Virologic Failure, and Implications for AIDS Management: A Systematic Review

Abstract

Antiretroviral therapies (ARTs) have revolutionized the management of human immunodeficiency virus (HIV) infection, significantly improved patient outcomes, and reduced the mortality rate and incidence of acquired immunodeficiency syndrome (AIDS). However, despite the remarkable efficacy of ART, virologic failure remains a challenge in the long-term management of HIV-infected individuals. Virologic failure refers to the persistent detectable viral load in patients receiving ART, indicating an incomplete suppression of HIV replication. It can occur due to various factors, including poor medication adherence, drug resistance, suboptimal drug concentrations, drug interactions, and viral factors such as the emergence of drug-resistant strains. In recent years, extensive efforts have been made to understand and address virologic failure in order to optimize treatment outcomes. Strategies to prevent and manage virologic failure include improving treatment adherence through patient education, counselling, and supportive interventions. In addition, the regular monitoring of viral load and resistance testing enables the early detection of treatment failure and facilitates timely adjustments in ART regimens. Thus, the development of novel antiretroviral agents with improved potency, tolerability, and resistance profiles offers new options for patients experiencing virologic failure. However, new treatment options would also face virologic failure if not managed appropriately. A solution to virologic failure requires a comprehensive approach that combines individualized patient care, robust monitoring, and access to a range of antiretroviral drugs.

Navigating the Antiretroviral Therapy Switch Conundrum: Unveiling the Dilemma of Drug Resistance and Disease Progression in HIV/AIDS

“…However, due to the challenges involved in diagnosing the condition and the various reasons why ARV failure occurs, the burden of treatment failure is not extensively documented [6]. HIV drug resistance, inadequate dose, drug interactions, poor adherence, and inadequate medication absorption are important contributing factors that lead to antiretroviral (ARV) therapy failure that should be recognized and addressed [7]. To overcome this precarious predicament, a more effective approach must be adopted.…”

A Review of FDA-Approved Anti-HIV-1 Drugs, Anti-Gag Compounds, and Potential Strategies for HIV-1 Eradication

“…The last updated World Health Organization (WHO) report indicated that globally about 39.0 million people acquired HIV-1 and 630,000 people died from HIV-1-dependent problems at the end of 2022 [5]. Furthermore, HIV-1/AIDS provokes opportunistic infections including tuberculosis, cryptococcal infection, histoplasmosis, and severe bacterial infections; hepatitis B, and C co-infections [6][7][8]; and comorbidities such as cardiovascular, kidney, and liver disorders and cancer [9]. In the near future, COVID-19 and monkeypox virus infections could be possible challenges for clinicians and people with HIV-1 [10,11].…”

HIV–TB Coinfection: Current Therapeutic Approaches and Drug Interactions

“…When the CD4+ T cell count drops below 200 cells/mm 3 , HIV is said to have progressed to AIDS. Antiretroviral therapy (ART) continues to be the standard treatment for HIV/AIDS, often consisting of various classes of ART drugs used in combination to suppress viral activity, enhance immune activity, and prevent disease progression [7]. A standard HIV regimen includes a combination of three anti-HIV medications from a minimum of two Viruses 2024, 16, 321 2 of 13 drug classes.…”

“…A standard HIV regimen includes a combination of three anti-HIV medications from a minimum of two Viruses 2024, 16, 321 2 of 13 drug classes. ART is not curative; however, it has been shown to reduce HIV transmission and prolong the lives of those living with HIV [7].…”