Track B report by Omar Sued
Anton Pozniak addressed the advances in ART since 2006. Currently, ARV drugs allow successful control of HIV and relatively normal life spans because in patients with more than 500 CD4/mL the mortality became similar to the general population. Current regimens have demonstrated better efficacy, less adverse effects, and are available in better formulations. In symptomatic patients, the soon initiation of the therapy is associated with lower mortality. Potential benefits of (immunological recovery, better ARV response, prevention of Non/AIDS events) stimulate earlier treatment, but no randomized evidence is available. The transmission resistance is another concern, in particular in areas where the cost prevents the routine use of this test. Several studies support initiate HAART with a NNRTI based regiment, even in advanced patients. Recent findings on toxicity of drugs (renal toxicity & TDF or CV risk & ABC) will probably impact on the choice of the NRTI backbone, although evidence linking CV toxicity and ABC is still controversial. In multi-drug resistant patients the recent incorporation of maraviroc, raltegravir and the new generation PIs have settled a new paradigm in experienced patients, by achieving a high rate of virological suppression. High number of treated individuals could reduce HIV transmission by reducing viral load at a population level. However, for every new person starting treatment 2-3 more are newly infected stressing the need to combine prevention and testing to ART. In conclusion, treatment works, but access to a wide range of antivirals is needed to treat patients wherever they live in the world.