Future treatment perspectives

Progress in antiretroviral therapy has resulted in dramatic achievements, such as the considerable reductions in morbidity and mortality observed in HIV-infected patients living in western countries, and new challenges, including the awareness of the long-term toxicities of antiretroviral (ARV) drugs and of viral cross-resistance. Changes in treatment guidelines have occurred as a result of data obtained from clinical trials but also of a better knowledge of the pathophysiology of the disease. Recommendations on when to start therapy in asymptomatic, chronically infected individuals have shifted to a more conservative approach. The availability of new assays, particularly resistance testing, is improving the ability of physicians to select individualized treatment regimens for patients with virological failure. The availability of new ARV drugs and the evaluation of new therapeutic concepts (including treatment simplification and treatment interruptions) may impact future directions of anti-HIV therapy. New drugs in development show promising antiviral activity, including activity against strains that are resistant to available agents, and this may help to circumvent cross-resistance.