What is the efficacy of antiretroviral therapy (ART) for HIV infection?

Updated: Oct 21, 2019
  • Author: Sowmya Nanjappa, MD; Chief Editor: John Bartlett, MD  more...
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Answer

Two large randomized controlled trials (Strategic Timing of Antiretroviral Therapy [START] [4] and TEMPERANO [5] ) evaluated the optimal time to initiate ART, and both demonstrated about a 50% reduction in morbidity and mortality among HIV-infected individuals with CD4 counts more than 500 cells/µL randomized to receive ART immediately versus delaying initiation of ART. Based on the START and TEMPRANO findings, the Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) has increased the strength and evidence rating for the recommendation on initiating ART to AI for all HIV-infected patients, regardless of CD4 count.

An AI rating is defined as a strong recommendation with high-quality evidence (ie, one or more randomized trials with clinical outcomes and/or validated laboratory endpoints).

An ART regimen for treatment-naive patients generally consists of two nucleoside reverse transcriptase inhibitors (NRTIs) in combination with a third active ART drug from one of three drug classes: an integrase strand transfer inhibitor (INSTI), a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor (PI) with a pharmacokinetic enhancer (ie, cobicistat or ritonavir). [2, 6]


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