Recent developments in HIV treatment and their dissemination in poor countries

As the world enters the fourth decade of the HIV/AIDS epidemic a number of new drugs have been developed that address current challenges with antiretroviral therapy (ART), such as pill burden, toxicity and drug-resistance. These new agents have not only been developed from established drug-classes, namely nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs), but also include innovative ways of suppressing viral replication. Intergrase inhibitors and chemokine receptor blockers have been developed which, combined with NRTIs, NNRTIs and PIs, comprise highly active antiretroviral therapy regimens able to tackle all aspects of the HIV life cycle with minimal toxicity. Furthermore, the ability of pharmaceutical companies to formulate these powerful drugs into fixed-dose combinations provides exciting new strategies for reducing pill burden, thus ensuring adherence and limiting the emergence of drug-resistance. The enthusiasm with which these new drugs have been received has, however, been tempered by the reality of limited access in the developing world, further highlighting the disparity between rich and poor countries in the fight against HIV/ AIDS. Access to these treatments in low- and middle-income countries will require the necessary political will, regulatory approval, affordability of drugs, as well as efficient procurement and supply management strategies. The priority of developing countries remains increased scale up of ART, but there is also a need to acquire new drugs in order to tackle toxicity and drug-resistance, both of which threaten the sustainability of such programmes. Thankfully, the vast majority of patients receiving ART in the developing world are still on first-line regimens, thus allowing time for newer agents to be made available as part of third-line treatment option. However, there is no room for complacency - the developing world needs access to new HIV treatments, an AIDS-free generation depends upon it.