Antiretroviral agents/therapy adherence

Although virologic failures have been uncommon in clinical trials of raltegravir to date, in vitro resistance requires only a single point mutation (eg, at codons 148 or 155). The low genetic barrier to resistance emphasizes the importance of combination therapies and of adherence. Integrase mutations are not expected to affect sensitivity to other classes of antiretroviral agents. 

Highly Active Antiretroviral Therapy (HAART) HAART slows or inhibits reverse transcriptase and protease enzymes by using several antiretroviral agents. HAART decreases the viral load. The viral load measures the amount of virus in the body. A decreased viral load causes an increase in CD4+ T cells and results in the immune system being able to identify, neutralize, and destroy non-self-cells. HAART therapy must be adhered to because the virus can become resistant to the antiretroviral agents. The patient must also adhere to nutritional therapy and avoid infections. 

The patient must adhere to HAART therapy as the virus becomes resistant and the antiretroviral agents lose their therapeutic effect. In addition, patients must avoid opportunistic infections and aggressive prophylaxis and treatment of opportunistic infections that do occur is recommended. Nutritional therapy, complementary therapy, and supportive care are also necessary. 

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