Antiretroviral Reduction: Is It Time to Rethink the Unthinkable?

Jonathan Colasanti; Vincent C. Marconi; Babafemi Taiwo


AIDS. 2014;28(7):943-947. 

In This Article

The Way Forward

A broadly applicable HIV cure remains elusive. Accordingly, the future as seen through today's lens holds lifelong cART as the primary option for patients. Inevitable consequences include cumulative costs for all and toxicities for many patients. With several once-daily STRs and FDCs now available and even more in development, we have arrived at an era when once-daily regimens can be provided for most patients. The core of current HIV treatment paradigm, however, defies the logic that the treatment of a chronic medical condition should be based on the individual's needs. More drugs are not necessarily better, and the cost of any unnecessary antiretroviral drug is an avoidable financial burden. Overall, there is a need to re-evaluate mono-ART and dual-ART regimens for HIV-1 treatment while ensuring the strategy is not associated with potential harm such as repopulation or expansion of viral reservoirs. A better understanding of the ideal patients for reductive ART may pave the road to maximum impact of long-acting agents as a panacea for treatment fatigue. The benefits of reductive ART to HIV-1-infected patients may be considerable if it proves to be well tolerated and effective in selected individuals.