Antiretroviral Therapy for HIV-Infected Adults

Definition

Antiretroviral therapy (ART) is the use of a combination of medications to suppress HIV replication, restore immune function, and prevent HIV-related morbidity and mortality in infected adults.

Epidemiology

• Global prevalence: ~38 million people living with HIV in 2024
• ART coverage has increased worldwide, with ~76% of diagnosed adults receiving therapy
• Higher prevalence in sub-Saharan Africa; increasing in Asia and Eastern Europe
• ART reduces HIV transmission and improves life expectancy
• Early initiation of ART recommended for all HIV-infected adults regardless of CD4 count

Etiology

• HIV-1 and HIV-2 infection leading to progressive immunodeficiency
• Transmission through sexual contact, contaminated blood products, or perinatal exposure
• ART targets viral replication to prevent CD4+ T-cell depletion
• No cure exists; lifelong therapy required to maintain viral suppression

Pathophysiology

• HIV infects CD4+ T lymphocytes and integrates into host DNA
• Viral replication leads to immune system destruction and opportunistic infections
• ART suppresses viral replication by targeting reverse transcriptase, protease, integrase, or entry processes
• Viral suppression allows immune reconstitution, reducing morbidity and mortality
• Failure of ART leads to drug resistance and progression to AIDS