Reverse Transcriptase Inhibitor

When to begin ART once HIV diagnosis is confirmed has been an area of research and debate for many years. The standard of care in the United States is to start ART when patients are agreeable to begin therapy, regardless of CD4 count. Often, though, there are barriers that may delay the start of HIV treatment. Lack of insurance coverage, active injection drug use, patient and provider attitudes toward treatment and opportunistic infection testing are all obstacles to beginning treatment, as well as numerous other factors. In many cases, HIV testing is done in settings other than where treatment is offered. This can delay ART by weeks or even months, depending on when the patient can be linked to HIV care. There are now clinics offering rapid ART initiation on the same day of HIV diagnosis to circumvent a delay in starting therapy due to a failure of patients to engage in care after their initial HIV diagnosis. Unfortunately, current HIV treatment guidelines are inconsistent when it comes to rapid initiation of ART. Both WHO and the International Antiviral Society (IAS)-USA treatment recommendations support immediate ART once HIV is diagnosed, including same-day ART initiation. However, HHS states that despite the potential benefits, ART initiation on the day of diagnosis remains investigational regarding its efficacy.

Findings from a pooled analysis of eight randomized controlled clinical trials showed that weight gain is “ubiquitous” in treatment-naive patients with HIV who initiate ART, and that it can be impacted by demographic factors such as race and gender, HIV-related factors, and the type of ART regimen, researchers reported.

The role of mutations in the development of drug resistance among patients with HIV involves several factors, according to Alan Taege, MD, of the department of infectious disease at Cleveland Clinic.