Since the 2015 Pipeline Report global antiretroviral treatment (ART) guidelines have moved to recommending "treat all" HIV positive people. With this recommendation comes the massive task of starting and keeping everyone with HIV on ART.
ART optimization is one of many critical steps to universal access to HIV treatment that is: safe, effective, tolerable, durable, simple and affordable.
Antiretrovirals can sometimes be optimized by dose reduction. Reducing an approved dose of a drug might be possible, because when new ones are developed, the highest tolerated doses in phase II are usually selected for phase III and approval. In some cases lower doses might have equivalent efficacy and better tolerability – as has been shown with efavirenz (EFV).
But since discussions on treatment optimization began the field has evolved and newer, better, and lower dose antiretrovirals have been approved. With a couple of exceptions, treatment optimization has shifted away from making older drugs more efficient. Speeding up the introduction of generic versions of newer drugs – in appropriate regimens and formulations – into low-and middle-income countries (LMIC) – is now the main focus of ART optimization.