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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Sexology Current recommended treatment for HIV/AIDS

Current recommended treatment for HIV/AIDS

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Currently there is no cure or vaccine for HIV/AIDS. The best known method of prevention is avoiding exposure to the virus. a course of antiretroviral treatment administered immediately after exposure (post-exposure prophylaxis) is believed to reduce the risk of HIV infection.

 

Current treatment protocol for HIV infection consists of highly active antiretroviral therapy, or HAART.

Current HAART options are combinations of at least three drugs belonging to at least two or classes of antiretroviral agents.

Typically, these classes are two nucleoside reverse transcriptase inhibitors (NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI).

Entry or fusion Inhibitors provide treatment options for patients who are infected with viruses already resistant to common therapies

Classes of antiviral drugs

 

Antiretroviral drugs

Examples

Nucleoside reverse transcriptase inhibitors

Zidovudine, Lamivudine, Didanosine, Stavudine, Zalcitabine

Non-nucleoside reverse transcriptase inhibitors

Nevirapine, Efavirenz, Delaverdin

Protease inhibitors

Indinavir, Ritonavir, Saquinavir,  Lopinavir

Fusion or entry inhibitors

Enfuvirtide

Nucleotide inhibitors

Tenfovir

Integrase inhibitors

Raltegravir

Chemokine co-receptor antagonists

Maraviroc

 

 

The current recommended treatment for HIV/AIDS

  • All patients with history of an AIDS-defining illness or severe symptoms of HIV infection regardless of CD4+ T cell count receive anti retro viral therapy (ART).
  • Antiretroviral therapy is also recommended for asymptomatic patients with less than 200 CD4+ T cells/µl.
  • Asymptomatic patients with CD4+ T cell counts of 201–350 cells/µl should be offered treatment.
  • For asymptomatic patients with CD4+ T cell of greater than 350 cells/µl and plasma HIV RNA greater than 100,000 copies/ml, most experienced clinicians defer therapy but some clinicians may consider initiating treatment.
  • Therapy should be deferred for patients with CD4+ T cell counts of greater than 350 cells/µl and plasma HIV RNA less than 100,000 copies/mL.

Typically, these classes are two nucleoside reverse transcriptase inhibitors (NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI).

  • Efavirenz + Zidovudine + Lamivudine
  • Ritonavir + Zidovudine + Lamivudine
  • Lopinavir boosted with Ritonavir + Zidovudine + Lamivudine
  • Nevirapine+ Tenfovir+ Zidovudine

Side effects of antiretroviral drugs 

 

Antiviral drug

Class

Adverse effects

Comments

Nucleoside Reverse Transcriptase Inhibitors

Zidovudine

Anemia, neutropenia, fatigue, malaise, headache, myalgia, myopathy, hyperpigmentation of skin and nails

Twice-daily dosing preferred over thrice-daily dosing. Reduce the dose in renal disorders.

 

Lamivudine

Headache, dry mouth.

Adverse effects occur infrequently. Active against hepatitis B virus

 

Didanosine

Pancreatitis, peripheral neuropathy, diarrhea

Concomitant alcohol use may increase risk of pancreatitis. Increased risk of peripheral neuropathy when combined with Stavudine.

 

Abacavir

Hypersensitivity syndrome (fever, myalgia, malaise, nausea, vomiting, symptoms suggestive of upper respiratory tract infection, anorexia)

In case of hypersensitivity syndrome, Abacavir must be discontinued permanently.

Non nucleoside Reverse Transcriptase Inhibitors

Nevirapine

Elevation in liver function test, hepatitis, liver failure

Hepatotoxicity may be life threatening. Monitor liver tests closely for the first 16 weeks of treatment.

 

Efavirenz

Abnormal liver function test, hyerlipidemia

Nervous system symptoms are common; severity usually decreases within 2-4 weeks.

Protease Inhibitors

Lopinavir/Ritonavir

Diarrhea, nausea, vomiting

, dyslipidemia, elevations in liver function tests, taste perversion, circum oral or perioral numbness.

 

Alcohol in the oral solution may cause disulfiram-like reaction.

 

Indinavir

Kidney stones, hyperuricemia, flank pain

Patients should drink at least 1.5 liters of fluid daily.

 

Saquinavir

Nausea, vomiting, and diarrhea, oral ulcerations

Must be used in combination with low-dose Ritonavir.

Fusion inhibitors

Enfuvirtide

Reduces the blood counts, increases the risk of pneumonia, allergic reaction at the site of injection.

 

 

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