antiretroviral therapy
antiretroviral therapy
Overview
Antiretroviral therapy (ART) is the standard-of-care treatment for human immunodeficiency virus (HIV) infection, comprising combinations of medications that suppress viral replication by targeting distinct stages of the HIV life cycle. Drug classes include nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs), the latter of which—exemplified by dolutegravir—now anchor most contemporary regimens globally. By reducing plasma HIV RNA to undetectable levels, ART prevents progressive immunodeficiency, substantially lowers the risk of opportunistic infections, and blocks onward transmission. Since its widespread adoption, ART has transformed HIV from a uniformly fatal disease into a manageable chronic condition, with most people living with HIV (PLWH) achieving near-normal life expectancy when virologically suppressed.
Despite these gains, ART does not cure HIV. Integrated proviruses persist within long-lived CD4+ T cell reservoirs—including CD4+ effector memory T cells—and rebound rapidly upon treatment interruption. Chronic immune activation, driven in part by residual viral antigen and coinfections, contributes to elevated levels of inflammatory markers such as C-reactive protein and mechanistic target of rapamycin kinase pathway dysregulation, linking long-term HIV infection to accelerated aging, cardiometabolic disease, and neurological injury even among virologically suppressed individuals. These residual pathologies define the frontier of contemporary HIV research and motivate ongoing work toward functional cure and ART-free remission.
Focus of Latest Publications
Recent publications on antiretroviral therapy (ART) have focused on both optimizing treatment delivery and understanding how ART interacts with adjunctive interventions, adherence behaviors, and HIV reservoir dynamics. Several studies examined ART in the context of differentiated service delivery and implementation research, including a randomized controlled trial of 6-month multi-month dispensing in China to assess retention and cost, a population-level analysis from British Columbia describing trends and short-term forecasts in ART utilization, and a multi-country analysis of HIV self-testing scale-up that tracked linkage to ART across eight African countries. Other work addressed contextual barriers to ART adherence, including alcohol use and tobacco smoking in Zambia, stigma, food insecurity, and limited social support among pregnant women living with HIV in Uganda, as well as neighborhood, transportation, and psychosocial influences on care engagement in Kenya.
A second cluster of studies centered on adherence support tools and tailored interventions. In Nigeria, the Lu Dedoo Project adapted a medication adherence app for adolescents and young adults living with HIV using a human-centered design framework to improve contextual relevance and usability before pilot testing. A separate mixed-methods study developed a geospatially customizable, culturally tailored just-in-time adaptive intervention for violence-affected people living with HIV, with the goal of supporting coping skills and improving ART adherence. These studies did not report efficacy outcomes in the abstracts provided, but they highlight growing interest in digital and behaviorally informed approaches to strengthen ART adherence in diverse populations.
Other publications explored ART in relation to HIV pathogenesis and immune recovery. One randomized trial protocol in acute HIV infection proposed combining pegylated interferon-α with ART to evaluate whether the combination could promote HIV reservoir reduction and immune reconstitution, reflecting the importance of early treatment for limiting reservoir establishment. Another study in acute HIV infection assessed neuroaxonal injury before and after immediate ART initiation, measuring cerebrospinal fluid biomarkers over follow-up to investigate potential neuroprotective effects. A modeling study also incorporated a cure rate representing ART efficacy or intrinsic immune clearance, using within-host HIV dynamics to examine how treatment and immune responses may influence infection outcomes.