Advances in antiretroviral therapy

Purpose of reviewTo review recent data about advances in ART.Recent findingsIn the last 2 years, clinical trials have demonstrated the safety and efficacy of three integrase transfer inhibitors [raltegravir (RAL), elvitegravir (EVG) and dolutegravir (DTG)], one new nonnucleoside reverse transcriptase inhibitor [rilpivirine (RIL)] and a new extended release formulation of nevirapine in antiretroviral-naive and experienced patients. Cobicistat (COBI), a new pharmacologic enhancer without antiretroviral activity has been studied as a booster of EVG and atazanavir (ATV). Two new single-pill fixed-dose combinations (FDCs) have been approved by regulatory agencies: RIL/tenofovir (TDF) difumarate/emtricitabine and elvitegravir/COBI/TDF difumarate/emtricitabine. A new prodrug of TDF is going to be evaluated in phase III clinical trials with the goal of showing less bone and renal toxicity. Ongoing trials are evaluating the use of nucleoside sparing regimens in antiretroviral-naive patients. Generic formulations of multiple antiretrovirals would become available in the immediate future. The efficacy and price reduction associated with generic antiretrovirals remains to be elucidated.SummaryIn the last 2 years, the antiretroviral armamentarium has been significantly expanded by the advent of the integrase transfer inhibitors RAL, EVG and DTG, by a new nonnucleoside reverse transcriptase inhibitor, RIL and by two new single-pill FDCs.