Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Henry, K.    Related Articles in PubMed    PubMed Citation    PubMed

PERSPECTIVE

The Case for More Cautious, Patient-Focused Antiretroviral Therapy

Keith Henry, MD

15 February 2000 | Volume 132 Issue 4 | Pages 306-311

Many clinicians who care for patients with HIV infection are dissatisfied with the existing recommendations on antiretroviral therapy. Current practice focuses on the early suppression of viremia, yet the outcome of that approach may not be in the best interest of individual patients or populations. The major goal of HIV therapy is to maintain the long-term health of the patient while avoiding drug-related toxicity and preserving viable future treatment options. Recent studies have challenged the principles on which recommendations for early, aggressive treatment were based. Key studies that lead to licensure of antiretroviral medications usually involve short-term results in treatment-naive patients; it is difficult to apply these results to long-term management of therapy-experienced patients. Early, aggressive therapy often prematurely exposes patients to risks for medication-related side effects and resistance. A more cautious, patient-focused, long-term approach to therapy would help foster studies of alternate strategies, such as delayed initiation of therapy, protease-sparing therapy, class-sparing therapy, planned drug interruptions, switches in therapy, and immune-based therapy. It is time for clinicians to rethink their approach to the treatment of HIV infection.

Author and Article Information

From Regions Hospital and the University of Minnesota, St. Paul, Minnesota.

Acknowledgments: The author thanks Christopher Sullivan, Holly Melroe, Alejo Erice, Henry Balfour, Ashley Haase, Winston Cavert, Courtney Fletcher, Edward Acosta, Pablo Tebas, Jennifer Palmer, and Ron Schut for their input.

Grant Support: By the National Institute of Allergy and Infectious Diseases and the Department of Health and Human Services.

Requests for Single Reprints: Keith Henry, MD, HIV Program, Regions Hospital and the University of Minnesota AIDS Clinical Trials Unit, 640 Jackson, Suite 125N, St. Paul, MN 55101; e-mail, keithh6680{at}aol.com.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

Related articles in Annals:

Editorials
Antiretroviral Therapy: Time To Think Strategically
Oren J. Cohen

Annals 2000 132: 320-322. [Full Text]  

This article has been cited by other articles:

				S. M. Shechter, M. D. Bailey, A. J. Schaefer, and M. S. Roberts The Optimal Time to Initiate HIV Therapy Under Ordered Health States Operations Research, January 1, 2008; 56(1): 20 - 33. [Abstract] [PDF]

				M. May, J. A C Sterne, M. Shipley, E. Brunner, R. d'Agostino, P. Whincup, Y. Ben-Shlomo, A. Carr, B. Ledergerber, J. D Lundgren, et al. A coronary heart disease risk model for predicting the effect of potent antiretroviral therapy in HIV-1 infected men Int. J. Epidemiol., December 1, 2007; 36(6): 1309 - 1318. [Abstract] [Full Text] [PDF]

				E. Martinez, J. A. Arnaiz, D. Podzamczer, D. Dalmau, E. Ribera, P. Domingo, H. Knobel, M. Riera, E. Pedrol, L. Force, et al. Substitution of Nevirapine, Efavirenz, or Abacavir for Protease Inhibitors in Patients with Human Immunodeficiency Virus Infection N. Engl. J. Med., September 11, 2003; 349(11): 1036 - 1046. [Abstract] [Full Text] [PDF]

				B. R. Schackman, K. A. Freedberg, M. C. Weinstein, P. E. Sax, E. Losina, H. Zhang, and S. J. Goldie Cost-effectiveness Implications of the Timing of Antiretroviral Therapy in HIV-Infected Adults Arch Intern Med, November 25, 2002; 162(21): 2478 - 2486. [Abstract] [Full Text] [PDF]

				T. R. Sterling, D. Vlahov, J. Astemborski, D. R. Hoover, J. B. Margolick, and T. C. Quinn Initial Plasma HIV-1 RNA Levels and Progression to AIDS in Women and Men N. Engl. J. Med., March 8, 2001; 344(10): 720 - 725. [Abstract] [Full Text] [PDF]

				R. E. Chaisson, J. C. Keruly, and R. D. Moore Association of Initial CD4 Cell Count and Viral Load With Response to Highly Active Antiretroviral Therapy JAMA, December 27, 2000; 284(24): 3128 - 3129. [Full Text] [PDF]

				R. Sharma Antiretroviral Resistance: Mechanisms, Detection and Clinical Implications Journal of Pharmacy Practice, December 1, 2000; 13(6): 442 - 456. [Abstract] [PDF]

				Antiretroviral Failure: A Biopsychosocial Approach AIDS Clinical Care, March 1, 2000; 2000(301): 1 - 1. [Full Text]