Twenty-five antiretroviral drugs available from six classes: the pace of the medical response to a virus that was only discovered 27 years ago has been truly remarkable. While combination antiretroviral therapy can now be expected to suppress the virus and prevent or halt disease progression for many years, treatment continues to fail in some individuals, often as a result of lapses in adherence and the development of drug resistance. When this occurs, the therapy has to be changed. Re-suppressing the virus and maintaining it at low levels for the lifetime of a patient requires careful choices to overcome drug resistance, stay one step ahead of viral evolution and minimise toxicity. Faced by the sheer complexity of resistance, the number of potential drug combinations available and the competing clinical and economic considerations affecting the treatment decision, successful individualised sequencing of antiretroviral therapy is highly challenging. These challenges are multiplied in resource-limited settings where there are fewer diagnostics, drugs and experienced HIV specialists to go round. This article describes a new approach: harnessing the clinical experiences of thousands of patients to power individualised and optimised treatment decision-making.
Articolo presente in – HAART and correlated pathologies n. 10 –