Antiretrovirals HAART

Kaposi sarcoma (KS) - an angiogenic-inflammatory neoplasm - is the most prevalent cancer in HIV-infected patients and its appearance is preceded by infection with human Heipesvitus-8 (HHV-8). Although chemotherapy has become the treatment of choice approved by the FDA, there are also good response rates in patients treated with IFN-a. Fortunately, today highly active antiretroviral therapy (HAART) has dramatically decreased the incidence of KS in AIDS patients. 

So far, five different protease inhibitors have been approved by the FDA for the treatment of HIV infection [3, 4]. Clinical trials in which protease inhibitors were evaluated in monotherapy demonstrated the potency of this class of inhibitors (decrease in HIV RNA levels, increase in CD4 cell counts). Treatment regimens were subsequently broadened to include reverse transcriptase inhibitors in combination with protease inhibitors. The result of these clinical trials has led to a list of guidelines with recommendations for the optimal treatment options. Prolonged control of the infection with combination therapy (highly active antiretroviral therapy, HAART ) could be shown. 

Highly active antiretroviral therapy (HAART) based on protease inhibitors or nonnucleoside reverse transcriptase inhibitors was introduced in the industrialized world during the second half of the 1990s. The majority of studies are based on data from the United States of America. 

Beck et al. (2004) presented an analysis of the cost-effectiveness of highly active antiretroviral therapy in Canada. They compared the cost-effectiveness from 1991 to 1995 (pre-HAART period) with the period from 1997 to 2001 (HAART period) for non-Aids and Aids groups. For the first group, they calculate total cost of US 4265 in the pre-HAART period and US 9445 in the HAART-period, whereas 66% and 84% were spent on antiretrovirals. The incremental cost per life year gained was US 14,587, that is, the HAART technology is rather cost-effective. For the Aids patients, the total costs were US 9,099 in the pre-HAART period and US 11,764 in the HAART period, whereas 29% were for antiretrovirals in the pre-HAART era and 72% in the HAART era. The incremental cost per life year gained by introducing HAART was US 12,813, so that HAART seems cost-effective in Canada. 

Chang L, Ernst T, Witt MD, Ames N, Walot I, Jovicich J, DeSUva M, Trivedi N, Speck O, Miller EN (2003) Persistent brain abnormalities in antiretroviral-naive HIV patients 3 months after HAART. Antivir Ther 8(1) 17-26... 

HAART highly active antiretroviral therapy HRCT high-resolution computed tomography... 

HAART Highly-active antiretroviral therapy IPG Impedance plethysmography... 

The unprecedented benefits resulting from highly active antiretroviral therapy (HAART) have been well described in the medical literature and there is agreement that symptomatic patient and those with AIDS require antiretroviral therapy. However, the... 

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