New Frontiers in HIV Antiretroviral Treatment: From the Management of Metabolic Complications and Chronic Inflammation to New Long-Acting Regimens

HIV treatment has changed drastically during the last few years, with efforts to improve virological efficacy but also patients quality of life. In the modern long-life antiretroviral therapy, drugs need to show not only efficacy, bute good tolerability and high adherence to obtain durability. In this way clinicians have been able to optimize treatment of HIV patients with good long-term results. In HIV cohorts, in fact, most of patients shows plasmatic viral suppression. In the management of HIV infection, however, there is not only the stable control of viral replication, but other important aspects that must be evaluated by clinicians. Most of patients have dyslipidemia, in some cases associated to weight gain and/or to atherosclerotic plaques. Furthermore, metabolic complications may also be associated to inflammatory markers inducing higher cardiovascular risk. All these elements are different pieces of an unsolved puzzle entering the new era of treatment characterized by long-acting drugs.

In the long-term management of HIV patients, clinicians have to pay attention to metabolic disorders and evaluate the role and impact of chronic inflammation. This is important to prevent comorbidities and premature aging that could negatively impact patients’ survival more than the same virus. Clinicians may improve these conditions acting on health care, promoting healthy eating, adding drugs necessary for dyslipidemia and changing antiretrovirals that may be related to metabolic disorders or to weight gain. This may be however more complicated with next advent of long-acting drugs that may be less manageable due to their peculiar pharmacokinetics. Therefore, we aim to explore the future role of metabolic complications and inflammation in the context of patients who will be treated with long-acting drugs and how clinicians will be able to face up to metabolic disorders when they will use drugs with so long half-life and less opportunity of short-term management.

The aim of this Research Topic is to analyze controversial aspects related to this new way of perceiving treatment. Long-acting regimens will likely be important to improve patients’ quality of life, but on the other hand, there will be other aspects that clinicians have to consider. In particular it may be interesting to analyze dynamics of lipids and inflammation markers in this type of administration, because these conditions will remain again the weakness of antiretroviral treatment for the future. We have to understand definitely how these aspects will be related to new long-acting treatment and how this will complicate management of these regimens. In this sense a review about peculiarities of long-acting treatment or an opinion may be interesting and useful to deepen this topic.