antiretroviral therapy

Overview

Antiretroviral therapy (ART) is the standard-of-care treatment for human immunodeficiency virus (HIV) infection, comprising combinations of medications that suppress viral replication by targeting distinct stages of the HIV life cycle. Drug classes include nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs), the latter of which—exemplified by dolutegravir—now anchor most contemporary regimens globally. By reducing plasma HIV RNA to undetectable levels, ART prevents progressive immunodeficiency, substantially lowers the risk of opportunistic infections, and blocks onward transmission. Since its widespread adoption, ART has transformed HIV from a uniformly fatal disease into a manageable chronic condition, with most people living with HIV (PLWH) achieving near-normal life expectancy when virologically suppressed.

Despite these gains, ART does not cure HIV. Integrated proviruses persist within long-lived CD4+ T cell reservoirs—including CD4+ effector memory T cells—and rebound rapidly upon treatment interruption. Chronic immune activation, driven in part by residual viral antigen and coinfections, contributes to elevated levels of inflammatory markers such as C-reactive protein and mechanistic target of rapamycin kinase pathway dysregulation, linking long-term HIV infection to accelerated aging, cardiometabolic disease, and neurological injury even among virologically suppressed individuals. These residual pathologies define the frontier of contemporary HIV research and motivate ongoing work toward functional cure and ART-free remission.

Focus of Latest Publications

Recent publications on antiretroviral therapy (ART) have focused on both optimizing treatment delivery and understanding how ART interacts with adjunctive interventions, adherence behaviors, and HIV reservoir dynamics. Several studies examined ART in the context of differentiated service delivery and implementation research, including a randomized controlled trial of 6-month multi-month dispensing in China to assess retention and cost, a population-level analysis from British Columbia describing trends and short-term forecasts in ART utilization, and a multi-country analysis of HIV self-testing scale-up that tracked linkage to ART across eight African countries. Other work addressed contextual barriers to ART adherence, including alcohol use and tobacco smoking in Zambia, stigma, food insecurity, and limited social support among pregnant women living with HIV in Uganda, as well as neighborhood, transportation, and psychosocial influences on care engagement in Kenya.

A second cluster of studies centered on adherence support tools and tailored interventions. In Nigeria, the Lu Dedoo Project adapted a medication adherence app for adolescents and young adults living with HIV using a human-centered design framework to improve contextual relevance and usability before pilot testing. A separate mixed-methods study developed a geospatially customizable, culturally tailored just-in-time adaptive intervention for violence-affected people living with HIV, with the goal of supporting coping skills and improving ART adherence. These studies did not report efficacy outcomes in the abstracts provided, but they highlight growing interest in digital and behaviorally informed approaches to strengthen ART adherence in diverse populations.

Other publications explored ART in relation to HIV pathogenesis and immune recovery. One randomized trial protocol in acute HIV infection proposed combining pegylated interferon-α with ART to evaluate whether the combination could promote HIV reservoir reduction and immune reconstitution, reflecting the importance of early treatment for limiting reservoir establishment. Another study in acute HIV infection assessed neuroaxonal injury before and after immediate ART initiation, measuring cerebrospinal fluid biomarkers over follow-up to investigate potential neuroprotective effects. A modeling study also incorporated a cure rate representing ART efficacy or intrinsic immune clearance, using within-host HIV dynamics to examine how treatment and immune responses may influence infection outcomes.

Key Publications

• NEWJul Effectiveness of pegylated interferon-α combined with antiretroviral therapy on HIV reservoir clearance in acute HIV infection: study protocol for a randomised controlled trial at a tertiary infectious disease hospital in Beijing, China. (BMJ open, 2026, PMID 42392622): "Pegylated interferon-α (Peg-IFN-α) exhibits potent antiviral and immunomodulatory properties that may enhance reservoir clearance when combined with antiretroviral therapy (ART)."
• NEWJun A Geospatially Customizable Culturally Tailored Just-in-Time Adaptive Intervention for Violence-Affected People Living With HIV: Mixed Methods Acceptability, Feasibility, and User Experience Study. (JMIR human factors, 2026, PMID 42360924): "...with cascading effects on key HIV continuum of care end points, such as antiretroviral therapy adherence."
• NEWJul HIV Care Retention and Cost Analysis in Multi-Month ART Dispensing: A Randomized Controlled Trial in China. (Journal of the International AIDS Society, 2026, PMID 42339560): "This study aimed to evaluate the impact of 6-month MMD of antiretroviral therapy (ART) on retention and conduct a cost analysis in China."
• NEWJun Alcohol consumption and tobacco smoking associated with decreased antiretroviral therapy adherence among people living with HIV in Zambia: Evidence from a 2023 national NCDs/ HIV survey. (PloS one, 2026, PMID 42284276): "In order to achieve the 95-95-95 goals and obtain optimal benefits from ART, PLWH must adhere to prescribed medication."
• May Adapting a medication adherence app for adolescents and young adults in Makurdi, Benue State: The Lu Dedoo Project. (PloS one, 2026, PMID 42213746): "Adolescents and young adults living with HIV (AYALHIV) face persistent challenges with antiretroviral therapy (ART) adherence, a key determinant of viral suppression and long-term health outcomes."
• May A modified HIV model with Beddington-DeAngelis incidence and cure rate. (Scientific reports, 2026, PMID 42191796): "It further includes a cure rate for infected cells, representing the efficacy of antiretroviral therapy or intrinsic immune clearance, and logistic growth for CD4[Formula: see text] T-cell populations."
• May Multimodal approach to exploring neighbourhood and transportation dynamics in HIV care in Kenya: protocol. (BMJ open, 2026, PMID 42082219): "Achieving viral suppression depends on consistent adherence to antiretroviral therapy (ART), but individuals in neighbourhoods perceived as disorderly often show low self-efficacy for ART adherence."
• May Scaling Up HIV Self-Testing in Africa: Insights From National Programmatic Data in Eight Countries. (Journal of the International AIDS Society, 2026, PMID 42051152): "...and linkage to antiretroviral therapy (ART) have evolved."
• May Evolution and forecasting of antiretroviral therapy utilisation in British Columbia: a population-level analysis of provincial drug treatment programme data, 2014-2024. (BMJ open, 2026, PMID 42055616): "To characterise temporal trends in antiretroviral therapy (ART) utilisation and forecast short-term changes in regimen distribution within a provincial HIV treatment programme."
• Apr Stigma, Food Insecurity, and Limited Social Support as Psychosocial Correlates of Antiretroviral Therapy Adherence Among Pregnant Women Living With HIV: Cross-Sectional Study. (JMIR public health and surveillance, 2026, PMID 42044489): "Adherence to antiretroviral therapy (ART) during pregnancy is critical for maternal health and the prevention of vertical HIV transmission."