In this issue of Science Translational Medicine, Shen and colleagues provide novel insights into the effectiveness of these drugs ( 5).
Given the robust capacity for the virus to evolve in response to almost any antiviral pressure, many clinicians, researchers, and patients remain dubious about the prediction that antiretroviral drugs will work for everyone and for decades, yet the emerging clinical data suggest that this is indeed happening. The virus is known to replicate in several cellular and tissue sanctuaries any one of these might serve as a source for low-level replication and eventual escape.
Resistance to certain drugs given as monotherapy can emerge and dominate in the virus population in 14 days ( 4). HIV replicates at a high titer and mutates constantly. The fact that therapy is so effective remains a puzzle. Although a cure has been elusive, long-lasting and perhaps lifelong control of HIV replication can be achieved in essentially all patients who have access to these drugs and who are able to adhere to the dosing requirements. Since the mid 1990s when combination therapy first became available ( 1, 2), the death rate from HIV has declined substantially ( 3). Antiretroviral therapy has changed human immunodeficiency virus type 1 (HIV-1) infection from a death sentence to a treatable chronic illness.
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