Approaches to antiretroviral therapy in HIV-infected patients with low CD4 lymphocyte counts

There are increasing numbers of patients with late-stage HIV infection in the Russian Federation. To choose optimal antiretroviral therapy regimens for patients with severe immunosuppression is a relevant problem. According the data obtained in the ECHO and THRIVE, ARTEMIS, CASTLE, SPRING-2 and other trials, the efficacy and/or safety of efavirenz are higher than those of rilpivirine, comparable with those of raltegravir and dolutegravir; darunavir and atazanavir are more effective than lopinavir, but dolutegravir is more effective than raltegravir (in numerical terms) in patients with low CD4 lymphocyte counts (less than 50 cells/mu l or 200 cells/mu l depending on a trial. To choose therapy for patients with late-stage HIV infection is an intricate problem and requires an individual approach that will take into account not only the efficiency of therapy, but also its possible side effects, as well as potential drug interactions for the treatment of opportunistic infections.