HIV Treatment: Antiretroviral Therapy, Immune Monitoring, and Resistance Prevention Strategies

The HIV treatment landscape has evolved significantly since the introduction of antiretroviral therapy (ART), transforming HIV/AIDS from a fatal disease into a manageable chronic condition. However, the success of ART relies on several factors, including treatment adherence, immune monitoring, and the prevention of viral resistance. These elements are crucial to ensure the long-term efficacy of treatment and to enhance the quality of life for patients.

Diving Deeper into Antiretroviral Therapy and Monitoring

Antiretroviral therapy has proven to be highly effective in suppressing the virus, but its success largely depends on patient adherence to the prescribed regimen. Non-adherence can lead to the emergence of resistance, complicating treatment management and limiting future therapeutic options. Studies have shown that drug resistance is a significant issue, particularly in resource-limited settings where viral load monitoring may not be routine.

Immune monitoring through CD4 level measurement is essential for assessing treatment response and detecting therapeutic failures. However, monitoring based solely on CD4 may not be sufficient to identify virological failures, highlighting the importance of integrating viral load testing whenever possible. A study in India emphasized that WHO immunological criteria have low sensitivity for detecting virological failures, which can lead to unnecessary switches to second-line therapies and compromise future treatment options.

Conclusions and Recommendations

To optimize HIV treatment, it is crucial to implement strategies that enhance treatment adherence and regular viral load monitoring. Patient education and ongoing support are fundamental to preventing the emergence of viral resistance. Furthermore, the availability of viral load testing should be a priority in treatment programs, especially in resource-limited regions, to ensure effective and sustainable management of HIV/AIDS.

Referencias

• [1] Emergence of HIV drug resistance during first- and second-line antiretroviral therapy in resource-limited settings
• [2] HIV-1 Disease Progression and Drug Resistance Mutations among Children on First-Line Antiretroviral Therapy in Ethiopia
• [3] Evaluation of WHO immunologic criteria for treatment failure: implications for detection of virologic failure, evolution of drug resistance and choice of second-line therapy in India

Created 6/1/2025