New antiretroviral therapy and its role in HIV treatment in Asia

Non-nucleoside analog reverse transcriptase inhibitor (NNRTI)-based therapy including fixed-dose combinations (tenofovir/emtracitabine/efavirenz in the developed world, or stavudine or zidovudine/lamivudine/nevirapine in the developing world) has been used widely as preferred first line therapy. However, NNRTIs have a low genetic barrier to resistance which increases the chance of treatment failure in poorly adherent patients. Newer antiretroviral drugs, including etraverine, darunavir, maraviroc, and raltegavir, have demonstrated efficacy and safety in patients who have experienced at least two classes of antiretrovirals. With appropriate use of these new drugs, in combination with other active antiretroviral agents, the goal of suppression of viral load below 50 copies can be achieved. This article is a review of currently available and future new antiretroviral drugs for second line and salvage therapies in resource-limited settings.