Principles of Anti-Retroviral

Therapy
Learning objectives
• Describe objectives of ART
• Review evidence base of the recommendation of ART
• List the principles of ARV
• Elaborate the 10 commendations of ART
• List indicators to monitor the efficacy and safety of ART
• Define ARV resistance and list factors that contribute to resistance
• Explain how to ARV resistance is monitored

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 François-Xavier Bagnoud Center

Clinical Progression

NY/NJ AETC LPS

Objectives of ART
• Goal of ART treatment
• Primary aim to prevent chronic HIV-associated mortality & morbidity at low
cost of drug toxicity

• Objectives of HIV Treatment :

• Suppression of Virus replication (decrease viral load).
• Restoration of immunocompetency to host.
• Decrease opportunistic infections.
• prolonged survival.
• Improve physical & psychological well-being of PLWH
 DHHS Guidelines Update 2014: Recommended
Regimens in ARV Naives Regardless of Baseline
CD4 and Viral Load
NNRTI – Based Regimen
Efavirenz/tenofovir/emtricitabine (AI)
PI – Based Regimens:
Atazanavir/ritonavir + tenofovir/emtrictiabine (AI)
Darunavir/ritonavir + tenofovir/emtricitabine (AI)
INSTI – Based Regimens:
Dolutegravir plus abacavir/lamivudine – ONLY if patient HLA-B*5701 negative (AI)

Dolutegravir plus tenofovir/emtricitabine (AI)

Elvitegravir/cobicistat/tenofovir/emtricitabine – ONLY if pre-ART CrCl >70ml/min (AI)
Raltegravir plus tenofovir/emtricitabine (AI)

Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-
1-infected adults and adolescents. Department of Health and Human Services. Available at
http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf. Accessed 5/2/14
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