Pillars of long-term antiretroviral therapy success.

Background: Meeting the challenge of antiretroviral therapy (ART) whose efficacy can last a lifetime requires continuous updating of the virological, pharmacological, and quality of life outcomes to be pursued and a continuous review of literature data on the efficacy and tolerability of new drugs and therapeutic strategies.
Methods: With the aim of identifying open questions and answers about the current controversies in modern ART, we adapted the Design Thinking methodology to the needs of the design phase of a scientific article, involving a team of experts in HIV care.
Results: Five main pillars of treatment success were discussed: sustained virologic suppression over time; immunological recovery; pharmacological attributes; long-term tolerability and safety of ART; and people's satisfaction and quality of life. The definition of the outcomes to be achieved in each thematic area and the tools to achieve them were reviewed and discussed.
Conclusions: Long-term treatment success should be intended as a combination of HIV-RNA suppression, immune recovery, and high quality of life. To achieve this, the regimen should be well-tolerated, with high potency, genetic barrier, and forgiveness, and should be tailored by a person-centered perspective, based on individual needs, preferences, and therapeutic history.
Competing Interests: Declaration of Competing Interest This study was supported by an unrestricted grant from Gilead. The company had no role in designing the study, collecting or analyzing the data, interpreting the results, or writing or approving the article. Outside the submitted work, LT attended advisory boards or served as consultant or received grants for conferences participations from Gilead Sciences, ViiV Healthcare and Janssen and research grants for her institution from Gilead Sciences; ADB has received speakers’ honoraria from Gilead, ViiV, Janssen-Cilag, has been advisor for ViiV, Janssen-Cilag, MSD and had received grant for research from Gilead. MS has received funds for attending symposia, speaking and organizing educational activities from ViiV Healthcare, Janssen-Cilag and Theratechnologies. EF received speakers’ honoraria, research grants and advisory board fees from Viiv Healthcare, Gilead Sciences, Merck Sharp & Dohme and SOBI. AC has received funding for scientific advisory boards, travel, or speaker honoraria from Gilead Sciences, ViiV healthcare, Janssen-cilag, MSD.GG received research grant and speaker honorarium from Gilead, ViiV, MERCK and Jansen and attended advisory boards of Gilead, ViiV and MERCK. MA received payment or honoraria for lectures, presentations, or educational events from Gilead Sciences, AbbVie, ViiV healthcare, Janssen and Tibotec, support for attending meetings and/or travel from Gilead Sciences, AbbVie, ViiV healthcare; he attended advisory boards of Gilead Sciences, Moderna, Astra Zeneca and Pfizer. SDG has received advisory board fees from Viiv Healthcare, Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme. ADM has received grants for her instituition by Viiv gilead msd janssen and has received fees for advisory boards by Viiv, Gilead Sciences, MSD, Gsk, Pfizer. PM received grant for publication, advisory board fees, and conference hospitality from Gilead Science, advisory board fees from ViiV Healthcare, advisory board fees and conference hospitality from MSD and Janssen. SC has served as a paid consultant to Gilead Sciences, Janssen-Cilag, Merck and ViiV Healthcare and received research funding through National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS from Gilead Sciences. BMC reports honoraria for presentations and scientific advice from Gilead Sciences, Bristol Myers Squibb, AbbVie, ViiV Healthcare, Janssen‐Cilag, Mylan and MSD and research grants for his institution from Gilead Sciences, ViiV Healthcare and MSD. NG has received travel support, grants and honoraria from Gilead, MSD, ViiV Healthcare, Janssen-Cilag. LS received travel grants from Gilead, Merck, Pfizer, fee for lectures and expertise from Merck, Gilead, Abbvie, Angelini, research funding from Gilead. SR received travel grants from Gilead, Janssen, attended advisory boards from Merck, Gilead, ViiV, GSK and received research funding from Gilead, Janssen, ViiV. SLC has been advisor for Gilead, ViiV, Janssen-Cilag, GSK, MSD and Astra Zeneca, had received speakers’ honoraria from Gilead, ViiV, MSD, Astra Zeneca, GSK and Janssen-Cilag, had received support for travel meetings from Gilead, Janssen-Cilag, and ViiV, had received grant for research from Gilead. AG received speaker’s honoraria and fees for attending advisory boards from ViiV Healthcare, Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme, Bristol-Myers Squibb, GSK, Pfizer, Novartis and received research grants from ViiV, Bristol-Myers Squibb, GSK, MSD, Angelini, Janssen-Cilag and Gilead. AA has served as a paid consultant to Astra Zeneca, Gilead Sciences, GSK, Janssen-Cilag, Merck, Moderna, Pfizer, Roche, and ViiV Healthcare and received research funding through National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS from Astra Zeneca, Gilead Sciences and ViiV Healthcare. RG received grants from ViiV, Merck, Gilead, Abbvie, Janseen and research funding from ViiV. CM received grant from Gilead and attended advisory boards of Gilead Sciences, ViiV Healthcare, MSD, Janssen. MZ received grants for research and educational activities from Gilead Sciences, Merck Sharp and Dohme, Theratechnologies, ViiV Healthcare and received personal fees for advisory boards and speaker's bureau from Gilead Sciences, GlaxoSmithKline, Janssen-Cilag, Merck Sharp and Dohme, Theratechnologies and ViiV Healthcare. GiuM has been advisor for Gilead, ViiV, Shionogi, Angelini, had received speakers’ honoraria from Gilead, ViiV and had received support for travel meetings from Gilead, Janssen-Cilag, and ViiV. GD has been advisor for Gilead, ViiV, Janssen-Cilag, GSK, MSD and Pfizer, had received speakers’ honoraria from Gilead, ViiV, MSD, Pfizer and Janssen-Cilag, had received support for travel meetings from Gilead, and ViiV and had received grant for research from Gilead. PB received grants for advisory boards or or honoraria for lectures from Gilead, Viiv, Merck; Jannsen, Pfizer. CM attended adivisory board and/or received speaking honoraria from ViiV, MSD, Pfizer, Astra-Zeneca, Gilead, Janssen-Cilag, GSK. GioM Has been advisor for Gilead, ViiV, Janssen-Cilag, GSK, MSD and Astra Zeneca, had received speakers’ honoraria from Gilead, ViiV, MSD, Astra Zeneca, GSK and Janssen-Cilag and had received support for travel meetings from Gilead, Janssen-Cilag, and ViiV. GDP has received fees for lectures and participation to advisory boards from Abbvie, GS, ViiV, GSK, Pfizer, AZ, Roche, MSD, Janssen.SB has received speaker's fees, advisors boards' fees or research Grant from Viiv, Gilead Sciences, Merck-Sharp and Dome, Jannssen Cilag and Abbvie. GR has participated to advisory boards and/or received fees for lectures from Gilead Sciences. AbbVie, Angelini, Janssen, GSK, and ViiV Healthcare; he received grants/ research support from Abbvie, Gilead Sciences, MSD and GSK. VE has been advisor for Gilead, ViiV, Janssen-Cilag, MSD and Astra Zeneca, received speakers’ honoraria from Gilead, Astra Zeneca, GSK and Janssen-Cilag and received support for travel meetings from Gilead, Janssen-Cilag, and ViiV, received grant for research from Gilead MSD and ViiV. The other authors did not declare conflicts of interest.
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