Treatment of advanced HIV infection

Abstract

In summary, although limited, current evidence does not support the use of non-boosted protease inhibitors for the treatment of advanced HIV infection. In this hard-to-treat population, clinicians should favour using drugs that have proven efficacy in the setting of low CD4 cell counts and/or high viral loads. The old controversy, about the comparative merits of protease inhibitors versus non-nucleosides, should no longer be discussed as if all the drugs within each family were identical. We are now in the seventh year of the HAART era. Enough clinical trials and cohort studies have shown that there are important differences among specific antiretroviral drugs. Expert guidelines should incorporate available data to individualize more precisely the level of recommendation for each drug in the same group. For patients with advanced HIV infection, evidence is starting to show that highly potent drugs, such as efavirenz or lopinavir/ritonavir, might be more appropriate than non-boosted protease inhibitors.