New Antiretrovirals: What's in It for Southern Africa?(Clinical: ART‪)‬

Previously, the only clinical consequence of HIV viral replication was thought to be a declining CD4 cell count, and development of resistance if on antiretroviral therapy (ART). Several recent studies have dramatically changed that understanding. Continuing viral replication seems to play a role in a bewildering array of illnesses not usually associated with HIV, including a diverse number of cancers, as well as chronic liver, kidney and cardiovascular disease. Viraemia used to be regarded as a necessary evil. In the 1990s, an undetectable viral load was more the exception than the norm in developed countries, owing to drug toxicity and poor adherence. Increasing evidence that persistent viraemia is linked to the host of long-term consequences described above has changed the game. In 2009, a detectable viral load should probably be regarded as the notional equivalent of active cigarette smoking, and tackled with the same vigour.