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2. Quicker, Simpler, and Better Antiretroviral Therapy


Modern antiretroviral therapy (ART) is highly effective and well-tolerated, but researchers continue to refine, streamline, and optimize treatment strategies. Studies presented this year show the benefits of starting ART as soon as possible after HIV diagnosis and suggest that fewer drugs taken less often may be effective for many people.

U.S., European, and World Health Organization HIV treatment guidelines, supported by findings from the START trial, now recommend that everyone diagnosed with HIV should start antiretroviral therapy regardless of CD4 T-cell count. The latest U.S. guidelines, released in January, emphasize the benefits of early treatment.

Last year a study of the RAPID program at San Francisco General Hospital showed that starting ART on the same day as HIV diagnosis led to more rapid viral suppression. This year researchers reported that faster ART initiation improved outcomes in the RapIT trial in South Africa and in real-world settings in Haiti and Swaziland.

Researchers also looked at ART simplification. The small PADDLE study showed that a 2-drug regimen of dolutegravir (Tivicay) plus lamivudine (Epivir and generics) led to sustained viral suppression for most people starting ART for the first time. Boosted darunavir (Prezista) plus lamivudine or boosted atazanavir (Reyataz) plus lamivudine maintained viral suppression among people who switched from standard 3-drug regimens, as did a dual combination of dolutegravir plus rilpivirine (Edurant) in larger Phase 3 trials.

A pilot study showed that a "4 days on, 3 days off" antiretroviral regimen kept viral load fully suppressed in a French study, as did Atripla (efavirenz/tenofovir/emtricitabine) taken just 3 times a week.

In the pipeline, long-acting injectable cabotegravir and rilpivirine administered once every 4 or 8 weeks maintained viral suppression in the LATTE-2 trial, while the monoclonal antibody ibalizumab may offer a new option for people with highly drug-resistant virus who cannot be successfully treated with available therapies.

NEXT: 3. Renewed Focus on HIV Vaccines and Antibodies