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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 21, Suppl C, Pages 1C-15C
Antiretroviral Therapy in 2010

Challenges in Initiating Antiretroviral Therapy in 2010

Cécile L Tremblay,1,2 Jean-Guy Baril,3 David Fletcher,4 Donald Kilby,5 Paul MacPherson,6 Stephen D Shafran,7 and Mark W Tyndall8

1Division of Infectious Diseases, Centre Hospitalier de L’Université de Montréal-Hotel Dieu, Canada
2Department of Microbiology and Immunology, University of Montreal, Canada
3Clinique du Quartier Latin and Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
4Maple Leaf Medical Clinic, Toronto, Canada
5University of Ottawa, Canada
6Ottawa Health Research Institute; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Division of Infectious Diseases, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
7Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
8Division of Infectious Diseases, University of British Columbia, BC Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, British Columbia, Canada

Received 23 March 2010; Accepted 6 July 2010

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Many clinical trials have shown that initiating antiretroviral therapy (ART) at higher rather than lower CD4 T cell-positive counts results in survival benefit. Early treatment can help prevent end-organ damage associated with HIV replication and can decrease infectivity. The mainstay of treatment is either a non-nucleoside reverse transcriptase inhibitor or a ritonavir-boosted protease inhibitor in combination with two nucleoside reverse transcriptase inhibitors. While effective at combating HIV, ART can produce adverse alterations of lipid parameters, with some studies suggesting a relationship between some anti-retroviral agents and cardiovascular disease. As the HIV-positive population ages, issues such as hypertension and diabetes must be taken into account when initiating ART. Adhering to ART can be difficult; however, nonoptimal adherence to ART can result in the development of resistance; thus, drug characteristics and the patient’s preparedness to begin therapy must be considered. Reducing the pill burden through the use of fixed-dose antiretroviral drug combinations can facilitate adherence.