Redefining therapeutic success in HIV patients: an expert view

Abstract

Thanks to advances in the field over the years, HIV/AIDS has now become a manageable chronic condition. Nevertheless, a new set of HIV-associated complications has emerged, related in part to the accelerated ageing observed in people living with HIV/AIDS, the cumulative toxicities from exposure to antiretroviral drugs over decades and emerging comorbidities. As a result, HIV/AIDS can still have a negative impact on patients' quality of life (QoL). In this scenario, it is reasonable to believe that the concept of therapeutic success, traditionally associated with CD4 cell count restoration and HIV RNA plasma viral load suppression and the absence of drug resistances, needs to be redefined to include other factors that reach beyond antiretroviral efficacy. With this in mind, a group of experts initiated and coordinated the RET Project, and this group, using the available evidence and their clinical experience in the field, has proposed new criteria to redefine treatment success in HIV, arranged into five main concepts: rapid initiation, efficacy, simplicity, safety, and QoL. An extensive review of the literature was performed for each category, and results were discussed by a total of 32 clinicians with experience in HIV/AIDS (4 coordinators + 28 additional experts). This article summarizes the conclusions of these experts and presents the most updated overview on the five topics, along with a discussion of the experts' main concerns, conclusions and/or recommendations on the most controversial issues.

Figure 1.

Cycle diagram showingthe five concepts proposed for the redefinition of therapeutic success in HIV patients and the key recommendations/areas for improvement for each of them. DDI, drug–drug interactions; HRQoL, health-related quality of life; NAFLD, non-alcoholic fatty liver disease; PLWH, people living with HIV; PROs, patient-reported outcomes; PVL, plasma viral load; QoL, quality of life; STRs, single-tablet regimens. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.