Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Over the past years, several drugs have become available to fight both the HIV infection and its associated infections and cancers. These drugs are called highly active antiretroviral therapy (HAART)
and have substantially reduced HIV-related complications and deaths. However, medications do not cure HIV/AIDS. In one case, a patient treated for cancer apparently was cured of HIV through use of a stem cell transplant, but this "stem cell cure" is not recommended for HIV due to the high risk of mortality and uncertain chance of success. Another case involved a baby in Mississippi who was treated aggressively
30 hours after birth with antiretroviral drugs and is now off HIV drugs and considered "functionally cured." This is, however, an isolated event.
Therapy is initiated and individualized under the supervision of a physician who is an expert in the care of HIV-infected patients. A combination of at least three drugs is recommended to suppress the virus from replicating and boost the immune system. The following are the different classes of medications used in treatment.
inhibitors: These drugs inhibit the ability of the virus to make copies of
itself. The following are examples:
Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs): These include medications such as zidovudine (AZT/Retrovir), didanosine (ddI/Videx),
stavudine (d4T/Zerit), lamivudine (3TC/Epivir), abacavir (ABC/Ziagen), emtricitabine (FTC/Emtriva), and tenofovir (TDF/Viread). Combination NRTIs include Truvada (tenofovir/emtricitabine), Combivir
(zidovudine/lamivudine), Epzicom (abacavir/lamivudine), and Trizivir (abacavir/zidovudine/lamivudine).
Non-nucleoside reverse transcriptase inhibitors (NNRTIS) are commonly used in combination with NRTIs to help keep the virus from multiplying. Examples of NNRTIs are efavirenz (Sustiva), nevirapine (Viramune), delavirdine (Rescriptor),
and etravirine (Intelence). Rilpivirine (Edurant), the newest member of this class of drugs, was approved by the U.S. FDA in May of 2011.
Two complete HIV treatment regimens that combine two NRTIs and one NNRTI in one pill taken once a day are available for convenience.
Atripla: a combination of efavirenz, emtricitabine, and tenofovir. Atripla was approved for use by the FDA in 2006.
Complera: a combination of rilpivirine, emtricitabine, and tenofovir. This combination pill was approved in August 2011 by the FDA as another first-line treatment for HIV infection in patients who need to start therapy.
Fusion and entry inhibitors are newer agents that keep HIV from entering human cells. Enfuvirtide (Fuzeon/T20) was the first drug in this group. It is given in injectable form like insulin. Another drug called
maraviroc (Selzentry) binds to a protein on the surface of the human cell and can be given by mouth. Both drugs are used in combination with other anti-HIV drugs.
Integrase inhibitors stop HIV genes from becoming incorporated into the human cell's DNA. This is a newer class of drugs recently approved to help treat those who have developed resistance to the other medications or used in initial treatment in combination with NRTIs. Raltegravir (Isentress) was the first drug in this class approved by the FDA in 2007. Elvitegravir is the latest integrase inhibitor developed and FDA-approved in 2012 as a component of a fixed-dose combination pill taken once daily called Stribild (elvitegravir/cobicistat/tenofovir/emtricitabine).
Antiretroviral viral drugs stop viral replication and delay the development of AIDS. However, they also have side effects that can be severe. They include decreased levels of red or white blood cells, inflammation of the pancreas, liver toxicity, rash, gastrointestinal problems, elevated cholesterol level, diabetes, abnormal body-fat distribution, and painful nerve damage. An expert in infectious diseases should be consulted if the patient needs concomitant treatment for diseases such as cancer or hepatitis C.
Pregnant women who are HIV-positive should seek care immediately because HAART therapy reduces the risk of transmitting the virus to the fetus. Therapy can also be given during childbirth, or perinatal period, in order to help prevent HIV infection in the newborn. There are certain drugs, however, that are harmful to the baby. Therefore, seeing a physician to discuss anti-HIV medications is crucial.