What is antiretroviral therapy for HIV infection?

Updated: Apr 18, 2019
  • Author: R Chris Rathbun, PharmD, BCPS (AQ-ID), AAHIVP; Chief Editor: John Bartlett, MD  more...
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An estimated 36.7 million people are infected with HIV worldwide. [1] In the United States, more than 1.1 million people have HIV infection, and almost 1 in 7 (14%) are unaware of their infection. The estimated incidence of HIV in the United States has declined by 18% between 2008 and 2014, and is now at about 40,000 new infections occurring each year. [2]

Significant advances in antiretroviral therapy have been made since the introduction of zidovudine (AZT) in 1987.

With the advent of highly active antiretroviral therapy (HAART), HIV-1 infection is now manageable as a chronic disease in patients who have access to medication and who achieve durable virologic suppression. [3]

Excess mortality among patients with AIDS was nearly halved in the HAART era (see the image below) but remains approximately 5 times higher in patients with AIDS than in HIV-infected patients without AIDS. Risk factors for excess mortality include a viral load greater than 400 copies/mL, CD4 count less than 200 cells/mL, and cytomegalovirus retinitis. [4]  Despite reductions in mortality with antiretroviral therapy, overall mortality remains 6 times higher in persons with HIV than the general population. [5]

Changes in survival of people infected with HIV. A Changes in survival of people infected with HIV. As therapies have become more aggressive, they have been more effective, although survival with HIV infection is not yet equivalent to that in uninfected people. Modified from an original published by Lohse et al (2007), "Survival of persons with and without HIV infection in Denmark, 1995-2005."

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