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HIV/AIDS (cont.)

HIV/AIDS Treatment and Medications

Over the past years, several drugs have become available to fight both the HIV infection and its associated infections and cancers. These drugs are commonly 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, was thought to be "functionally cured" from HIV, but has since been found to be infected with HIV.

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.

  • Reverse transcriptase inhibitors: These drugs inhibit the ability of the virus to make copies of itself. The following are examples:
  • Protease inhibitors (PIs): These medications interrupt virus replication at a later step in its life cycle, preventing cells from producing new viruses. These include ritonavir (Norvir), a lopinavir and ritonavir combination (Kaletra), saquinavir (Invirase), indinavir sulphate (Crixivan), fosamprenavir (Lexiva), darunavir (Prezista), atazanavir (Reyataz), tipranavir (Aptivus), and nelfinavir (Viracept). Using PIs with NRTIs reduces the chances that the virus will become resistant to medications. Atazanavir and darunavir are available in combination with cobicistat as atazanavir/cobicistat (Evotaz) and darunavir/cobicistat (Prezcobix). Cobicistat is a drug that inhibits CYP3a, an enzyme in the body involved in the breakdown of chemicals. Cobicistat will, therefore, increase the amount of atazanavir and darunavir exposure in the body.
  • 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 second integrase inhibitor developed and FDA-approved in 2012 as a component of a fixed-dose combination pill taken once daily called elvitegravir/cobicistat/tenofovir/emtricitabine (Stribild). Dolutegravir (Tivicay) is the latest integrase inhibitor FDA-approved in 2013 for initial treatment of HIV. It is also available in a once-daily combination pill with two NRTIs, abacavir and lamivudine, called Triumeq.

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, hepatitis B, 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.

Although it is important to receive medical treatment for HIV/AIDS, home remedies or alternative medicine are commonly used along with standard HIV treatment to improve overall health. It is important to talk to your doctor before trying alternative therapies as some can interfere with HIV drugs.

Medically Reviewed by a Doctor on 5/5/2015
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