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.

中文翻译：

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2010年开展抗逆转录病毒疗法的挑战

许多临床试验表明，以较高而不是较低的CD4 T细胞阳性计数开始抗逆转录病毒治疗（ART）会带来生存益处。早期治疗可以帮助防止与HIV复制相关的终末器官损害，并可以降低感染性。治疗的主要药物是非核苷类逆转录酶抑制剂或利托那韦增强的蛋白酶抑制剂与两种核苷类逆转录酶抑制剂组合。尽管抗病毒有效抗击艾滋病，但抗逆转录病毒疗法可产生脂质参数的不利变化，一些研究表明某些抗逆转录病毒药物与心血管疾病之间存在关联。随着艾滋病毒阳性人群的年龄增长，在开始抗病毒治疗时必须考虑到诸如高血压和糖尿病等问题。坚持抗病毒治疗可能很困难；然而，对ART的非最佳依从性可能导致耐药性的发展；因此，必须考虑药物特性和患者开始治疗的准备情况。通过使用固定剂量的抗逆转录病毒药物组合减少药丸负担可以促进依从性。