Antiretroviral therapy (ART) for the treatment of HIV infection has improved steadily since the advent of potent combination therapy.
With the advancement in HIV treatment, there has been significant improvement in the safety and tolerability of regimens.
Antiretroviral therapy has dramatically reduced HIV- associated morbidity and mortality and has transformed HIV disease into a chronic, manageable condition.
The pill burden and dosing frequency for ARVs have been reduced and adverse events minimized, contributing to success rates in the initial treatment.
In addition, recent evidence confirms that successful viral suppression through treatment can substantially reduce the risk of vertical, sexual, and blood-borne HIV transmission.
ARVs have been used effectively as prophylaxis to prevent mother-to-child transmission (PMTCT) and as post-exposure prophylaxis.
There is convincing evidence that ART reduces HIV transmission at the individual and community levels.
Effective implementation of ART will also result in other prevention benefits, including lower rates of tuberculosis, lower incidence of pregnancy-related deaths among started soon after HIV diagnosis and patients are virologically suppressed.
Therefore, the time lag between an HIV diagnosis and treatment should be reduced drastically through early testing of asymptomatic individuals and early linkage to care and antiretroviral therapy.
The principal aim of antiretroviral therapy is to prevent morbidity and mortality in people with HIV and AIDS by durably suppressing viremia to undetectable levels, and thereby reconstituting and maintaining immune capacity.
HIV and AIDS cannot be cured by using currently available ARV regimens because, during acute HIV infection, some viruses hide in certain tissues(sanctuaries), where they stay dormant or with very minimal replication for a life time.
Very early initiation of ART reduces the number and size of sanctuaries, and once patients are initiated on ART, they need to be maintained on lifelong treatment.
For individuals with severe immunosuppression or TB co-morbidity, ART should be started as soon as possible.
However, ART should be initiated for patients with cryptococcal meningitis after five weeks of meningitis treatment to avoid associated mortality.