Simplifying antiretroviral therapy

The complexity and toxicity of antiretroviral regimes handicap the long-term benefits of therapy in HIV-infected individuals. Issues such as lowering the pill burden and avoiding drugs more likely involved in the development of lipodystrophy often arise in clinical practice. Despite the disappointing results of early induction-maintenance trials, attempts to simplify antiretroviral therapy should not be prematurely discarded. Patients with long-standing undetectable viral load (<20-50 copies/mL) and CD4+ lymphocyte counts within safe ranges might be considered good candidates for simplification. Possible strategies, based on the pursued aims and a case-by-case assessment, are outlined. Among others, switching from protease inhibitors to non-nucleosides can be attempted safely in subjects having sustained virological response for a while.