**14. Conclusion**

cells. SDS *in vitro* and in animal models have inhibitory activity against HIV-1 and HSV [272], promoting the reduction of adsorption of the HIV viral envelope glycoproteins in the mem‐ brane of the target cell [273]. In the form of a thermoreversible gel acts as a physical barrier and as a denaturing agent of the viral envelope glycoproteins [272, 273]. In similarity with nonoxynol 9, its long time application can cause non-specific damage to the vaginal epithelium

156 Trends in Basic and Therapeutic Options in HIV Infection - Towards a Functional Cure

PrEP using intravaginal rings (IVR) with antiretroviral drugs, is emerging as a promising strategy for the prevention of sexual HIV-1 infection [274]. The use of IVR as controlled release strategy of antiretroviral drugs may improve adherence to PrEP, and provide sustained mucosal levels independent of coitus and daily dosing [275]. The delivery of two or more antiretroviral drugs from conventional IVR designs involves significant technological and manufacturing challenges [276]. Recently, an IVR was developed which allows the release of multiple agents over a wide range of target delivery rates and aqueous solubilities [277-279]. Researchers have evaluated the pharmacokinetics of IVR containing five drugs as a proof-ofconcept, described as advanced multipurpose prevention technology, which combines three antiretroviral drugs from different mechanistic classes (tenofovir, nevirapine, and saquinavir) with a proven estrogen-progestogen contraceptive for prevention of HIV-1 infection and unintended pregnancy [280, 281]. Studies with IVR delivering TDF and emtricitabine, as well as a triple-combination IVR delivering TDF, emtricitabine, and selzentry are in progress for safety and pharmacokinetics evaluation. Preliminary results show that no adverse events were observed, although certain toxicological findings were observed. Mild-to-moderate increases in inflammatory infiltrates were observed in the vaginal tissues of some animals in both the presence and absence of IVR [277-281]. New perspectives and challenges are open for the development of IVR delivering multiple drugs, to ensure the safety and efficacy for the

Changes in diet and lifestyle, and the adequacy of a hypocaloric diet are recommendations that seek to reduce the concentrations of TC and its fractions, especially LDL [282-284]. These changes bring benefits over short periods of time and reduce the risk for cardiovascular and atherosclerotic diseases. The dietary recommendations are addressed to the entire population and specifically to HIV-1 patients which also indicates measures that should be applied to delay the need for lipid-lowering drugs, even before the treatment of dyslipidemia [282-285]. Changes in diet can directly alter the levels of circulating LDL including saturated fats, cholesterol, and trans-unsaturated fats. The highest impact comes from saturated fats, which are in a solid state at room temperature or under refrigeration. The major sources of saturated fats are meat and meat products (poultry, pork, beef, lard, and sausages), dairy (milk and

cells, uterine and cervical tissue.

prevention of HIV-1 infection [279-281].

**13. Diet and lifestyle**

**12. Intravaginal rings**

After more than three decades of the emergence of HIV/AIDS, it is clear the advances achieved with HAART in patients infected with HIV-1. A better quality of life, reducing morbidity and mortality, and a greater survival rate are evident in patients who use the therapy. The therapeutic arsenal is wide, and many possibilities occurs in those cases where viral resistance, viral genetic mutations, presence of quasispecies and also adhesion problems of treatment and maintenance due to adverse reactions and side effects such as those produced on lipid metabolism. In turn, the advent of PrEP is undoubtedly the most important and innovative approach to prevent infection by HIV-1, and is already showing excellent results in several clinical studies conducted to date. Additionally, maintaining perspective of low viral load levels in patients who use HAART is considered as one of the keys to reducing the transmission of infection, and associated with PrEP, presents us with a positive scenario for the coming years. Beside the excellent results obtained with HAART , a definitive cure for HIV-1 remains a major obstacle. Nevertheless, nowadays patients infected with HIV-1 have a better perspec‐ tive of life.
