Access and well-modulated use of antiretroviral agents (ARVs) in North
America dates as early as 1990 with the initial guidelines recommended zidovudine
monotherapy, just 4 years after FDA approved the drug. Continued review of emerging
data, led to the recommendation of highly active antiretroviral treatment (HAART) in
1998. Clear documentation of access and use of antiretroviral therapy (ART) in
resource limited settings was first observed in 2002 after the World Health Organization
(WHO) issued guidelines for resource limited settings, and included key ARVs into the
WHO essential drug list. Delayed access to ART heavily impacted the initial control of
the HIV epidemic in resource limited settings, but even with improved access to ART,
differences in the management of HIV still exist; including timing for ART initiation
and HIV/ART monitoring strategies. Access to key HIV/ART monitoring tools
including viral load testing is limited in low resource settings, leading to gaps in
HIV/ART management that may no longer be experienced in resource rich settings.
Geographical variations in HIV sub-types and key co-infections further subject the
control and management of HIV to demographic influence. Until now, resource
availability and demographic differences are key determinants in treatment initiation
and regimen selection, while variable access to ART and key monitoring tools possibly
affect the HIV epidemic, making its control less effective in some settings.
Keywords: ART, Resource Settings, Resource Limited Settings, HIV, HIV/ART,
HIV sub-types, ART Guidelines, HIV Co-treatment, ART Criteria, ART
Timelines, ART Coverage.
