Treatment to cure HIV/AIDS is called antiretroviral therapy (ART). Matter of fact is the medications used do not cure this condition.
They only suppress the growth and multiplication of the virus and prevent it from further damaging the immune system of the person. This prevents opportunistic infections from setting in.
However, the treatment with drugs and medicines is successful in prolonging death and the HIV patient is able to live a normal lifespan. More importantly, it reduces the risk of the patient transmitting the infection.
ART reduces the levels of HIV (human immunodeficiency virus) to even undetectable levels, but the person still stays infective and can transmit the infection to others. However, as stated above, the risk of transmission is reduced.
Treatment for HIV and AIDS has to be taken lifelong and without breaks. Furthermore, it should be started as soon as possible.
After you first get infected with HIV, it takes from 5 to 12 years for the last HIV stage of AIDS to develop. This is the stage when opportunistic infections set in and the immune system of the body is damaged. The infections develop into serious diseases, which ultimately kill the patient within 2 to 3 years.
The management guidelines to cure HIV/AIDS specify not just the drugs, but also the include counseling, the various combination of drugs and the right time to start the treatment. They are explained below.
Counseling also forms part of the treatment to keep the mental state of the person stable and comfortable. This is necessary what with fear of death looming large.
HIV has been and is still associated with death. Counseling consists of removing that fear and giving information of the success rates of the ART and letting the patient know that life with ART can be lived to its full length.
But, with the advent of ART, a person on treatment for HIV can have a long life and can prolong his/her life for decades.
Such a person with HIV on treatment can live as long as the general population, which is not infected with HIV – thanks to research and treatments available today.
The name, antiretroviral therapy, comes from the fact that the HIV (Human Immunodeficiency Virus) is a retrovirus. A retrovirus is defined as a virus, which is an RNA virus that is duplicated in a host cell using the reverse transcriptase enzyme to produce DNA from its RNA genome.
There are different classes of ART drugs, which act on the virus during different periods of its life cycle. Presently, there are 31 antiretroviral drugs approved by the U.S. FDA.
Treatment of HIV and AIDS consists of a combination of three or more of these drugs. This combination therapy is called “the cocktail”.
It is now also called the Antiretroviral Therapy (ART) or the Highly Active Anti-Retroviral Therapy (HAART). The aim of treating with three or more drugs is to avoid producing resistant strains of the HIV to a single drug. This effective combination method of ART was first started in 1996.
This concept of three or more drugs treatment showed a 60% to 80% reduction in rates of AIDS and deaths in patients infected with HIV. Once started, treatment should not be stopped and has to be taken life long.
When to start antiretroviral therapy for HIV? Guidelines
When to start antiretroviral therapy in a patient infected with HIV has been a matter of controversy among the medical fraternity for long.
And, they all center on the CD4 count and the viral load. Opinions differ whether to start the therapy when the CD4 count falls below 350 or 500/mm3 from the normal levels of 500to 1200/ mm3.
The reason to delay starting the treatment is the high cost of the therapy and the toxic effects of the drugs, and also due to the fact expressed by some experts that the HIV can be controlled even when the therapy is started at this later stage of the disease. The following guidelines to commence ART will help:
- CD4 count falls below 500/mm3. The CD4 count tells you how strong your immune system is.
- HIV+ woman becomes pregnant
- Coexisting hepatitis B or hepatitis C
- HIV related kidney disease develops
- Stage of AIDS has set in. (meaning symptoms of opportunistic infections are severe)
- Viral load is high and the CD4 count is rapidly decreasing. Viral load is the amount of virus in the blood.
- The commitment of the patient to stick religiously to the prescribed treatment guidelines is important. Taking the doses as prescribed every day is necessary. An irregular taking of medicines can make the virus resistant to the drugs. The patient’s commitment, therefore, has to be evaluated.
However, these guidelines have changed over the years. The United States Department of Health and Human Services (DHHS) now recommends that antiretroviral therapy be started in all patients with HIV as soon as the infection is detected, irrespective of the CD4 count. This has come about for the following reasons.
- Newer and different drugs are available, which are less toxic and offer easy regimens.
- Earlier treatment decreases the risk of HIV transmission.
- Early treatment also reduces the risk of opportunistic infections and progression to AIDS.
Classes of drugs to treat HIV and AIDS
As mentioned above, there are different classes of drugs to treat HIV and AIDS and they all have a different mode of action on the virus during its life cycle.
A combination of drugs is used to treat HIV infection. The effective combination is to use three drugs from two different classes. This prevents producing a virus strain that can become resistant to a single drug.
The HIV is constantly mutating and trying to find ways to become resistant to the drugs. The combination therapy prevents this from happening because as soon as the HIV finds ways “to get around” one drug, there is another drug in the combination to prevent it from multiplying.
A combination of such antiviral drugs with fixed doses is available in one single pill for ease of administration.
Nucleoside reverse transcriptase inhibitors (NRTIs)
The drugs belonging to this class are called “nukes”. They act directly on the genetic material and block the DNA production of the virus, thus stopping the replication of the virus.
Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
These drugs are called the “non-nukes”. They block the action of the enzyme, reverse transcriptase, which prevents the virus from duplicating its DNA. Examples are efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
Protease inhibitors (PIs)
HIV infects the CD4 cells and copies its own genetic code into the DNA of the cell. This programs the CD4 cell to make new HIV genetic material and proteins.
For this, a protein enzyme called protease is required. PIs disable protease and prevent the HIV from making copies of itself, thus stopping its growth. Examples are atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).
Entry or fusion inhibitors
These drugs work differently than the drugs mentioned above. The above drugs, namely NRTIs, NNRTIs and PIs act on the HIV after it has entered the CD4 cells.
Entry inhibitors act by preventing the entry of the HIV from entering the CD4 cells. Examples are enfuvirtide (Fuzeon) and maraviroc (Selzentry).
HIV damages the immune system by incorporating its DNA into the DNA of the CD4 cells of the immune system. This is called integration and the HIV uses integrase, a protein for this process.
Integrase inhibitors disable this protein and prevent integration. Examples include raltegravir (Isentress), elvitegravir (Stribid) and dolutegravir (Tivikay).
How your right medicines and their combinations are chosen?
The aim of HIV/AIDS treatment is to find the right combination of HIV medicines and the right dosage that will control the HIV infection with minimal side effects. All the options should be discussed with your physician who is treating you for HIV.
Your physician takes several factors into consideration before choosing the drug combination to treat your HIV.
- Your general state of health and immunity judged by the CD4 count
- Your preference for doses – whether once a day or twice a day
- Your medical history and psychiatric history
- Possible side effects of the ART drugs
- Possible interactions with other drugs you may be taking for some other health condition – for example, hypertension and/or diabetes.
Besides medicines to treat your HIV, you may also be required to take other medications for the following reasons:
- Medicines to prevent pain or diarrhea or nausea, which can be side effects due to ART medicines.
- Medicines for other health conditions you may be having such as high blood pressure, any heart condition or diabetes.
- Prophylactic medicines for certain opportunistic infections you may at risk.
Examples of some HIV/AIDS combination include:
- Abacavir + dolutegravir + lamivudine, or ABC/DTG/3TC (Triumeq)
Efavirenz + emtricitabine + tenofovir, or EFV/FTC/TDF (Atripla, Tribuss)
- Abacavir + lamivudine, or ABC/3TC (Epzicom)
- Elvitegravir + cobicistat + emtricitabine + tenofovir, or EVG/COBI/FTC/TAF or ECF/TAF (Genvoya)
- Abacavir + lamivudine + zidovudine, or ABC/3TC/ZDV (Trizivir)
- Elvitegravir + cobicistat + emtricitabine + tenofovir, or EVG/COBI/FTC/TDF or ECF/TDF (Stribild)
- Emtricitabine + rilpivirine + tenofovir, or FTC/RPV/TAF (Odefsey)
- Emtricitabine + rilpivirine + tenofovir, or FTC/RPV/TDF (Complera)
- Emtricitabine + tenofovir, or TAF/FTC (Descovy)
- Emtricitabine + tenofovir, or TDF/FTC (Truvada)
- Lamivudine + zidovudine, or 3TC/ZDV (Combivir)