The Food and Drug Administration has approved antiretroviral therapy as the recommended treatment for the Human Immunodeficiency Virus (HIV) infection. The HIV treatment aims to fight HIV and the complications this virus creates by reducing the viral load in the body, stopping viral replication (multiplication), and restoring the immune functions of the body. It also aims to reduce the risk of viral transmission from the mother to the fetus and to delay the development of AIDS. But, it is important to remember that despite the HIV treatment options available, there is no complete cure for this infection yet.
HIV Treatment With Antiretroviral Therapy
Antiretroviral therapy is an individualized HIV treatment plan because each patient responds differently to medication. Doctors prescribe medication depending upon the stage of the disease, the patient’s willingness to undergo therapy, and the presence of any other health problems in the patient.
Classes Of Antiretroviral Drugs
Here are some of the anti-HIV drugs that are used to inhibit the virus replication cycle at various stages.
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
NNRTIs bind to and alter an enzyme named reverse transcriptase, which the virus needs to proceed with its replication. This action of the NNRTIs automatically slows down the spread of the virus in the body. Some common NNRTIs used include Efavirenz (Sustiva), Etravirine (Intelence), Nevirapine (Viramune), and Delaviridine (Rescriptor).
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
These are faulty versions of the building blocks that HIV needs for replication. NRTIs like Abacavir (Ziagen), Didanosine (ddI/Videx), Zalcitabine (ddC/Hivid), Stavudine (d4T/Zerit), and Lamivudine (3TC/Epivir) are commonly used. Abacavir (ABC/Ziagen), Emtricitabine (FTC/Emtriva), and Tenofovir (Viread) are some of the other NTRIs that are used for HIV treatment.
Protease Inhibitors (PIs)
Protease inhibitors prevent cells from producing new viruses at a later stage in the virus replication cycle, by inhibiting the functioning of an enzyme called protease. Some commonly used PIs are 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).
Entry Or Fusion Inhibitors (FIs)
Fusion inhibitors like Enfuvirtide (Fuzeon) and Maraviroc (Selzentry) block the entry of the HIV into CD4 cells.
Integrase inhibitors, such as Raltegravir (Isentress), work by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.
HAART (Highly Active AntiRetroviral Therapy)
Often, a combination of two or three antiretroviral drugs from different classes produces effective results in HIV treatment. Such a regimen is referred to as Highly Active AntiRetroviral Therapy or HAART. For example, HAART often combines 1 NNRTI with 2 NRTIs or PIs. This aims at lowering the levels of the virus in the blood till the virus is nearly undetectable.
This regimen is very important as the virus develops resistance to the drug when a single one is used for HIV treatment. Combination therapy helps reduce the dosage of the anti-HIV drugs while maintaining their effectiveness.
Some fixed dose combinations used as part of HAART include Abacavir-Lamivudine (Epzicom), Abacavir-Lamivudine-Zidovudine (Trizivir), Efavirenz-Emtricitabine-Tenofovir DF (Atripla), Elvitegravir-Cobicistat-Emtricitabine-Tenofovir DF (Stribild), Emtricitabine-Rilpivirine-Tenofovir DF (Complera), Emtricitabine-Tenofovir DF (Truvada), Lamivudine-Zidovudine (Combivir), and Lopinavir-Ritonavir (Kaletra).
Indications For HIV Treatment
Here are some of the indicators that point to a need for HIV treatment. Such treatment is required when the:
- Count of CD4 cells (immune cells) falls below 500
- HIV patient is pregnant
- HIV symptoms reach a critical stage
- HIV positive person is getting treated for Hepatitis B
- Patient has a HIV – related kidney disease
Side Effects Of Antiretroviral Therapy
One of the major drawbacks of antiretroviral therapy is the occurrence of some serious side effects such as:
- Liver toxicity
- Inflammation of the pancreas
- Reduction in the levels of Red Blood Cells (RBCs) and White Blood Cells (WBCs)
- Increased Cholesterol Levels
- Gastrointestinal problems (nausea, vomiting, diarrhea)
- Painful nerve damage
- Peripheral neuropathy
HIV treatment must be undertaken only as per the advice of a physician. In many cases of the disease, the anti-HIV drugs may work at cross purposes with medication used to treat other ailments, and can cause complications. For example, medication taken for the treatment of tuberculosis or Hepatitis C may interfere with anti-HIV medication. This may also happen in the case of contraceptives and hormonal medicines used by women.
The response of the patient to HIV treatment should be monitored by testing the viral load at the start of treatment and then every 3-9 months during the course of the treatment.
It is important to note that these medicines are not 100 % protective and HIV will continue to be present in the body of the infected individual. As the individual carries the risk of HIV transmission, he should take precautionary measures like avoiding unprotected sex, in order to prevent passing on the infection to another individual.