The science of antiretrovirals (ARVs) has taken a giant leap ahead...
Flash back to 1981, the first case of AIDS was declared by the Center of Disease Control (CDC) in the United States. AIDS then spread, taking the form of a pandemic, leaving lives shattered and people waiting for death with an incurable disease.
Since then the science of antiretrovirals (ARVs) has taken a giant leap ahead. Did you know that in the US in 2006, life expectancy if diagnosed HIV positive at 20 and supported with ARVs stood at another 52 years? This is up from 27 years in 1996. Living into your seventies is almost as good as normal life expectancy.
The goal of antiretroviral therapy (ART) is to control the viral load in the infected individual to reduce morbidity and raise life expectancy.
Further progress has been made on aspects related to when to start ART and in what combinations. The US Department of Health and Human Services (DHSS) recommends initiation of ART early, with a CD4 count in excess of 500. Some other agencies recommend going on to ARTs with a CD4 count between 350 and 400.
The clinical implications of early and delayed start of ART have been studied in great detail. The findings are in favour of an early start, also because of the clear treatment is prevention evidence.
There are a number of combination regimens that exist with the available ART choices. Mostly, a combination of Nucleoside Reverse Transcriptase Inhibitors (NRTI) and Non Nucleoside Reverse Transcriptase Inhibitors are used. Currently, ART is used for providing life saving support to people living with HIV. But the preventive use of ART is significant too including in Preventing Mother to Child Transmission (PTMCT) which has been a great success story with babies being born HIV-free.
The other preventive ways of using ART is treating discordant couples, Pre and Post Exposure Prophylaxis and use of microbicides.
More exciting work on ART science is in progress. There are a number of new agents in the pipeline including cobicistat, Integrase Inhibitors and CD4 Attachment inhibitors. The future focus of therapy is going to be on a one pill once daily regimen. Long acting ARVs are also being researched and tried, with an extended half life. These further developments are bound to improve quality of life further and will further increase life expectancy.
More than 30 years into the science of HIV and ART and today we have about 26 ARVs from six classes. They are currently available to around 8.75 million people worldwide, are extremely effective in treatment and prevention and their coverage has been successfully scaled up through a successful collaboration between the medical fraternity, academia, governments and civil society.
UNAIDS has a 15/15 target for ART: 15 million on ART by 2015 worldwide.
On the road to zero new infections and the battle against AIDS, ART is one of the most critical aspects.
COMMENTS
Thanks for sharing this Prakash!
I feel we should build on and promote best practices such as treatment as prevention and PMTCT which are producing significant results.