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JAC Advance Access published online on June 27, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl191
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading article

Benefits and concerns of simplification strategies in HIV-infected patients

Eugènia Negredo 1 *, Anna Bonjoch 1, and Bonaventura Clotet 1

1 Lluita contra la SIDA Foundation, HIV Unit, Universitat Autònoma de Barcelona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

* To whom correspondence should be addressed.
Eugènia Negredo, E-mail: enegredo{at}flsida.org


  Abstract

Highly active antiretroviral therapies (HAART) provide sustained viral control in most patients, but many of these regimens are restricted by complex dosing, drug-drug interactions and toxicities. Numerous strategies of simplified treatment have been explored in order to improve patient quality of life and adherence to treatment, as well as to manage drug-related toxicities while maintaining viral suppression. The first simplification strategy involved switching from protease inhibitors (PIs) to non-nucleoside reverse transcriptase inhibitors (NNRTIs), with an additional benefit on lipid metabolism. The development of once-daily drugs or co-formulated combinations has successfully been used to further simplify treatment. However, studies assessing triple nucleoside regimens have shown a higher frequency of viral failure in comparison with standard HAART, mainly in patients with previous sequential suboptimal treatments. Finally, NRTI-sparing approaches, consisting of NNRTI + PI combinations or monotherapies with boosted PIs, are alternatives to avoid NRTI-related mitochondrial toxicities. An accurate analysis of each patient's history will be necessary in each case to determine whether a simplification strategy is appropriate.

Keywords: HIV-infection; antiretroviral therapy; simplification strategies; efficacy; safety.
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