Abstract

Matthew Barnhart* and James Shelton

With 5.2 million people already receiving antiretroviral therapy (ART) in low and middle-income countries and 33.4 million people estimated to be living with HIV globally, there is an urgent need to develop better antiretroviral (ARV) regimens that are less costly and less complex to implement than the current standard of care. We think it is technically possible to develop such improved regimens soon, and discuss some illustrative examples of how new ARVs and treatment simplification approaches might simultaneously improve outcomes and dramatically reduce costs. Such regimens would: 1) include new ARVs that are more tolerable, durable, and inexpensive to manufacture; 2) contain a reduced number of ARVs; and/or 3) be amenable to directly observed dosing on a weekly or a monthly-basis. However, success will not only require technical solutions, but also good will and mechanisms to foster collaboration within the international community. Therefore, we also suggest a few priority actions that interested parties can take to help expedite the widespread availability of better ARV regimens.