HIV/AIDS Treatment

Medications

Over the past 10 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, there is no cure for HIV/AIDS. Therapy is initiated and individualized under the supervision of an expert physician 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 different classes of medications include

• Reverse transcriptase inhibitors: These drugs inhibit the ability of the virus to make copies of itself. Examples include



• Nucleoside or Nucleotide reverse transcriptase inhibitors (NRTIs). These include medications such as zidovudine (AZT/Retrovir®), didanosine (ddI/Videx®), zalcitabine (ddC/Hivid®), stavudine (d4T/Zerit®), lamivudine (3TC/Epivir®), abacavir (ABC/Ziagen®), emtricitabine (FTC/Emtriva®), and tenofovir (Viread®).



• 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®), and delavirdine (Rescriptor®). Etravirine (Intelence®), a newer member of this class of drugs, was approved by the FDA in 2008.



• 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®), amprenavir (Agenerase®), 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.



• Fusion and entry inhibitors are newer agents that keep HIV from entering human cells. Enuviritide (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. Raltegravir (Isentress) was the first drug in this class approved by the FDA, in 2007.

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.

• Pregnant women who are HIV-positive should seek care immediately because HAART therapy reduces the risk of transmitting the virus to the fetus. There are certain drugs, however, that are harmful to the baby. Therefore, seeing a physician to discuss anti-HIV medications is crucial.