Practice Therapeutics

Drug treatment for adults with HIV infection

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1555 (Published 23 April 2015) Cite this as: BMJ 2015;350:h1555
  1. Miriam Samuel, specialty registrar1,
  2. Alan Winston, clinical reader and consultant physician2,
  3. Barry Peters, reader and honorary consultant physician13
  1. 1St Thomas’ Hospital, London SE1 7EH, UK
  2. 2Section of Infectious Diseases, Department of Medicine, Imperial College London, UK
  3. 3Department of Infectious Diseases, King’s College London, London, UK
  1. Correspondence to: M Samuel Miriam.Samuel{at}nhs.net

The bottom line

  • Antiretroviral therapy (ART) has dramatically reduced the mortality associated with HIV, which can now be considered a chronic treatable disease. ART does not, however, cure HIV so treatment is life long

  • Effective ART reduces the risk of onward transmission of HIV to sexual partners and mother to child transmission

  • Many antiretroviral drugs interact with commonly prescribed drugs such as steroid inhalers. Clinicians should always check for drug interactions when patients are taking ART and seek specialist advice when unsure.

  • Antiretroviral therapy can only be initiated once a diagnosis of HIV is made. Delayed diagnosis of HIV and delayed initiation of ART can be associated with increased mortality

How patients were involved in the creation of this article

  • We sought guidance from an HIV positive treatment advocate who works to encourage people living with HIV to take an active role in their own health, and who coordinates the i-Base treatment information services

  • He reviewed a draft and advised us on both content and presentation

  • He suggested important changes to the tips for patients section, and in particular improved the clarity and readability for patients

A 65 year old man who had been living with HIV for the past 20 years visited his general practitioner for continued management of chronic obstructive pulmonary disease. His HIV was well controlled on an antiretroviral therapy (ART) regimen comprising tenofovir, emtricitabine, darunavir, and ritonavir. His GP thought that he would benefit from a combination inhaler (long acting β2 agonist and inhaled corticosteroid) but decided first to ask the HIV clinic about potential drug-drug interactions with ART.

What is antiretroviral therapy?

By suppressing HIV replication, ART limits further HIV associated pathology and enables immune recovery. The primary goal of ART is to reduce HIV morbidity and mortality in people with HIV. Guidelines also recommend its use to reduce the risks of onward transmission to sexual partners1 and of mother to …

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