TY - JOUR T1 - ARVs: The Next Generation. Going Boldly Together to New Frontiers of HIV Treatment JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 1 LP - 11 DO - 10.9745/GHSP-D-14-00243 VL - 3 IS - 1 AU - Matthew Barnhart AU - James D Shelton Y1 - 2015/03/01 UR - http://www.ghspjournal.org/content/3/1/1.abstract N2 - New antiretrovirals (ARVs), particularly the potentially “game-changing” ARV dolutegravir, offer major potential to meet the compelling need for simpler and better HIV treatment for tens of millions of people in the coming decade. Advantages include substantially lower manufacturing cost, fewer side effects, and less risk of resistance. But key obstacles must be addressed in order to develop and introduce new ARVs in specific combinations optimized for the needs of low- and middle-income countries. Strong leadership will be essential from the global health community to nurture more focused collaboration between the private and public sectors. The current and projected need for HIV treatment is simply stunning. Already, among the estimated 35 million people living with HIV, 13.6 million are receiving antiretrovirals (ARVs),1 with about 3 of every 4 people on antiretroviral therapy (ART) residing in sub-Saharan Africa.2 However, achieving expanded 2013 treatment guidelines from the World Health Organization (WHO) would require ART provision to about twice the current number. And many have recommended that all people living with HIV infection should receive ARVs. Moreover, over time as survival improves substantially, the number of people living with HIV will increase markedly. Additional special demands are ARVs for people for whom first-line therapy has failed, people with tuberculosis (TB), pregnant and lactating women, and children. At almost US$10 billion per year,2 international funding for HIV is the lion's share of all global health funding, and within that, support for HIV treatment is also the lion's share. That level of support seems to have plateaued, and indeed pressure is mounting for resource-constrained countries affected by HIV to take over more of the burden. Actually, more of the site-level costs of providing treatment comes from service delivery costs than from costs of the ARVs themselves; provision of services for established patients (excluding … ER -