WHY ART CALLED HAART WHAT IS COUNITY VIRAL LOAD
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ART is the acronym commonly used today to describe HIV antiretroviral therapy. Previous to this, clinicians and scientist would use the term cART (combination antiretroviral therapy), and previous to that the popular term HAART was used to describe "highly active antiretroviral therapy."
Whatever the acronym used, the term implies the use of three or more antiretroviral drugs, either taken individually or in fixed dose combinations. The aim of therapy is to ensure the suppression of HIV to so-called "undetectable" levels—meaning that the virus is not fully eradicated, but is simply beneath detection levels of current testing assays.
As opposed to single-drug or dual-drug therapy, the combination of three or more active drugs is known to effectively suppress the variety of resistant HIV that can exist within a viral population. Essentially, if one drug is unable to suppress a certain viral mutation, the others will likely be able to do so.
High levels of adherence are needed in order to maintain therapeutic drug levels in the blood. If these levels fall beneath the therapeutic threshold, resistant strains are provided an opportunity to thrive. The larger these resistant populations, the less effective the drugs will be in suppressing HIV replication—eventually leading to viral rebound and treatment failure.
Classes of ART
There are currently five classes of antiretroviral drug, each of which inhibit a specific stage in the HIV life cycle:
Entry or Fusion inhibitors (which include CCR5 receptor antagonists)
Nucleoside and nucleotide reverse transcriptase inhibitors (NRTI/NtRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Integrase inhibitors
Protease inhibitors
Other classes of antiretrovirals are being investigated, while newer-generation drugs aim to improve tolerability, reduce adverse effects and simplify dosing for those on therapy.
To this end, an increasing number of fixed dose combination (FDC) drugs are now available, combining two or more drug into a single pill or tablet. Some, including Atripla ((tenofovir + emtricitabine + efavirenz), Triumeq (abacavir + lamivudine + dolutegravir) and Stribild (tenofovir + emtricitabine + elvitegravir + cobicistat) offer all-on-one formulations for simplified, daily dosing.
Future of ART
With advances in HIV drug developments, ART is now being employed as a means to reverse infection rates in high prevalence HIV populations.The strategy, known as Treatment as Prevention (TasP), has been shown to reduce the risk of transmitting HIV by suppressing viral activity to undetectable levels. In doing so, the risk of transmission is reduced by as much as 96%.By ensuring widespread drug distribution, ART can lower the so-called "community viral load" (the median viral load within a community) to levels where the likelihood of transmission is significantly, even profoundly, reduced