Advances in antiretroviral therapy may transform HIV infection into a chronic illness

In the period 1997 to 1999, our clinical trial of antiretroviral therapy (ART) of high efficacy (HAART), published in "Revista Clinica Espanola", revealed only 7 ART in two families with 2 protease inhibitors (PI) for HAART regimens to treat HIV infection. However, at present we have 22 ART with 10 PI (tipranavir and darunavir with better resistance profile). There are new ART families: nonnucleosides, and fusion (enfuvirtide), CCR5 (maraviroc) and integrase (raltegravir) inhibitors. Methadone programs have changed the treatment of the parenteral drug users. Associated pharmaceutical preparations and a small number of tablets, two tablets/day, or one tablet/day, augment adherence and reduce adverse effects (lipodystrophy). Regarding our hospital cohort of 488 patients, in the 2008 transversal study (patients on HAART), 82% have viral load (A) less than 50 copies/ml and other 14% of the patients had VL of less than 500 copies/ml. These results do not coincide with those of our clinical trial (20% of patients had VL of less than 400 copies/ml). CD4 counts above 500/ml were present in 59.4% of the patients of the cohort, CD4 counts above 200/ml in 93.7%, and only 2.8% of the patients had less than 50 CD4/ml. At present, the general objective is to reduce the VL to less than 50 copies/ml; this is an important advance in the treatment of HIV infection and makes it a chronic infection.