Current recommendations support initiating cART with three drugs. Late diagnosis of HIV infection is frequent, in this setting some clinicians prefer to start with 4 drugs. Combinations of more than three drugs to initiate treatment in this population of patients is debated.
What's your opinion?
Dear Dinko, thanks for your answer. The clinical utility has not been established and a major concer is the Immune reconstitution inflammatory syndrome (IRIS) a widely recognised complication of antiretroviral therapy, observed in advanced immunodeficiency.
I found interesting the conclusions of a recent paper in J Acquir Immune Defic Syndr (2014;66:140–147) : Intensified 5-drug cART initiated during early infection fails to significantly further impact virologic or immunologic responses beyond those achieved with standard 3-drug PI based cART.
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