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HIV infection has been a greater challenge to current medicine than any other viral disease ofmodem times. HIV leads to a persistent infection and the virus has an immense genetic flexibility under selective pressure. During its replica tive cycle in patients, HIV accumulates mutations at such a high rate that the selective pressure inflicted on the immune system, or generated by antiviral drugs rapidly triggers the appearance of escape mutants. Currently available drugs, when used singly, are not capable of suppressing virus replication in patients to such a level that the generation of mutations, from which a variant resistant to immune attack or antiviral drugs can be selected, is prevented. This is the main reason why combination therapy, usually of three drugs, has become the standard procedure for the treatment ofAIDS. It is obvious that virus eradication will not readily be achievable, so that drugs have to be taken for a prolonged time or even lifelong so as to keep the viral load as low as possible. Whether the currently used drug combinations will be able to control virus replication in a particular patient for such a pro longed period of time depends on many factors, most of which are addressed in the different chapters of this book. The aim of antiviral drug combination therapy for AIDS is ultimately to restore full function of the immune system.
List of contents
Anti-HIV agents to be used in drug combination regimens.- A perspective of the history of HAART.- The basic principles for combination therapy.- Comparison of the efficacy of HAART: single, dual or triple-class antiretroviral therapy.- Pharmacokinetics and pharmacodynamics of HAART.- Primary HIV infection: from diagnosis to treatment.- Salvage therapy.- Structured therapy interruptions (STIs): lessons from a therapeutic strategy.- Immune reconstitution in HIV infection.- Highly active antiretroviral treatment (HAART) of pediatric HIV-1 infection.- Causes of HIV treatment failure.- Economic implication of HIV-1 resistance testing in overall clinical care.- Guidelines for antiretroviral therapy.- Visions for the future of antiretroviral therapy.
About the author
Erik De Clercq, M.D., PhD is currently President of the Rega Foundation, a member of the Belgian (Flemish) Royal Academy of Medicine and of the Academia Europaea, and a Fellow of the American Association for the Advancement of Science. He is an active Emeritus Professor of the Katholieke Universiteit Leuven (K.U.Leuven), Belgium. He is honorary doctor of the Universities of Ghent, Belgium, Athens, Greece, Ferrara, Italy, Jinan (Shandong), China, Charles (Prague), Czech Republic, and Jihoceska (Bude?jovice), Czech Republic.§For his pioneering efforts in antiviral research, Professor De Clercq received in 1996 the Aventis award from the American Society for Microbiology, and in 2000 the Maisin Prize for Biomedical Sciences from the Belgian National Science Foundation. In 2008 he was elected Inventor of the Year by the European Union. Together with Dr. Anthony Fauci, Prof. De Clercq received the Dr. Paul Janssen Award for Biomedical Research in 2010.§He is the (co)inventor of a number of antiviral drugs, used for the treatment of HSV (valaciclovir, Valtrex , Zelitrex ), VZV (brivudin, Zostex , Brivirac , Zerpex ), CMV (cidofovir, Vistide ), HBV (adefovir dipivoxil, Hepsera ), and HIV infections (AIDS) (tenofovir disoproxil fumarate, Viread ).
Summary
This volume provides an extensive clinical assessment of combination therapy of AIDS. Main focus is put on the Highly Active Antiretroviral Therapy (HAART) but other therapies like salvage therapy are also discussed. The chapters cover efficacy, treatment, causes of treatment failure, clinical care, guidelines, pharmacology and future perspectives.
