The treatment of HIV infection with antiretroviral therapy (ART) has evolved greatly since the 1987 FDA approval of zidovudine, a single agent to which the virus rapidly developed resistance. Today, health care providers prescribe multidrug regimens containing 2 or more medications with complementary mechanisms of action and/or treatment resistance profiles. When used as prescribed, ART can allow people with HIV (PWH) to achieve virologic suppression involving a viral RNA (vRNA) level in the person’s blood that is lower than the limit of detection for diagnostic assays (typically, < 200 vRNA copies/mL of blood). The 2014 PARTNER study revealed that virally suppressed PWH are incapable of sexually transmitting the virus to seronegative partners, a finding that would later evolve into the slogan Undetectable = Untransmittable (U = U). Additionally, the 2015 START trial (NCT00867048) demonstrated that initiating ART before substantial HIV-related immunosuppression significantly reduced the risk of disease progression to AIDS, transforming HIV from a fatal diagnosis to a manageable chronic condition. These treatment successes have prompted policymakers to pursue ambitious public health goals such as Ending the HIV Epidemic (EHE), a US public health initiative to reduce new HIV infections and control viral spread by the year 2030.
Key goals of EHE include, from 2017 to the end of 2025, reducing new HIV infections and diagnoses by 75%, increasing viral suppression among PWH to 95%, and increasing good or better self-rated health among diagnosed PWH to 95%. The progress demonstrated by data year 2022—the most recently available—must accelerate to meet 2025 targets; in particular, progress must be made towards increasing self-rated health, as progress declined as of data year 2022. As identified by the CDC, retention in care and achievement of viral suppression are persistent problems, with only 47% and 57% of PWH, respectively, achieving those metrics in data year 2022. Thus, needs among PWH that prevent care retention and successful, sustained achievement of viral suppression remain unmet.
Burdensome treatment effects may explain this problem. Even in the setting of well-controlled viral suppression, patients may be interested in switching, or may need to change, HIV treatment due to adverse events (AEs) or an anticipated drug interaction with a newly prescribed medication. The 2024 HIV treatment guidelines published by the US Department of Health and Human Services (HHS) identify AEs, drug-drug interactions (DDI), drug-food interactions (DFI), pill burden, cost, stigma, inconvenience of oral medications, and a desire to simplify a treatment regimen as valid reasons for PWH to switch from one HIV treatment regimen to another.
An article, published in the American Journal of Managed Care (AJMC), examines the HIV treatment landscape, focusing on how existing and emerging medications for virally suppressed PWH align with patient and public health goals. Further, it identifies remaining therapeutic gaps as the HIV treatment landscape and patient population continue to evolve.
Access the full article here.The article is part of the supplement ‘Managing HIV in 2025: Optimizing Treatment After Virologic Suppression’, which can be accessed here.
Â