Ten years of highly active antiretroviral therapy for HIV infection

• Over the past 10 years, the management of HIV infection has been transformed by an increased number of effective antiretrovirals (ARVs), with more convenient dosing and improved tolerability. • Optimal management of HIV infection includes at least three effective ARVs; from at least two different drug classes. • Current strategies and drugs can effectively control HIV and significantly reduce morbidity and mortality. However, no cure is yet possible. • Appropriate use of ARVs leads to suppression of virological replication (to below the limit of detection using commercial assays to measure HIV in plasma) and an increase in CD4⁺ T cells with few adverse effects. • Greater than 95% adherence to drug therapy is required for effective viral suppression and immunological improvement. • Monotherapy, two-drug combinations, sequential ARVs, drug "cycling", and treatment interruptions are ineffective management strategies and lead to earlier disease progression and emergence of drug resistance. • Drug-drug interactions are common and caution is required when prescribing ARVs that inhibit or induce the cytochrome P450 pathway.