Advances and challenges in antiretroviral therapy for acquired immunodeficiency syndrome

摘要

Since its first isolation in 1983, human immunodeficiency virus (HIV) has caused nearly 50 million deaths and affected millions of people worldwide. Combination antiretroviral therapy (ART) has been universally recommended for HIV infection owing to its beneficial effects on the replication and transmission control of HIV.[1] The World Health Organization eliminated the traditional CD4-based ART eligibility requirements in late 2015. Thus, ART is now recommended for all people living with HIV (PLWH) regardless of the CD4 level or clinical stage. Global declarations called for a 75% reduction in new HIV infections and acquired immunodeficiency syndrome (AIDS) deaths between 2010 and 2020 and an end to the HIV/AIDS epidemic by 2030 through achieving the 90-90-90 targets (90% of PLWH are diagnosed, of whom 90% are on treatment, of whom 90% are virally suppressed) set for 2020 by the Joint United Nations Programme on HIV/AIDS.[2] Although positive progress toward achieving these targets was observed in 2019, substantial gaps remain. It was estimated that globally 79% (67%–92%) of all PLWH know their status, 78% (69%–82%) of those who know their status are undergoing treatment, and 86% (72%–92%) of those on treatment have suppressed viral loads. Globally, an estimated 37.9 million (32.7–44.0 million) PLWH, with 1.7 million (1.4–2.3 million) new infections and 770,000 (570,000 to 1.1 million) AIDS-related deaths in 2018. A series of government-sponsored, multi-center studies have been performed over the years to guide the optimization of the HIV/AIDS treatment approach for HIV/AIDS patients, and some new advances have emerged.[2]