HIV Treatment guidelines

What is HIV:

HIV, commonly known as human immunodeficiency virus.

The human immunodeficiency viruses are basically two species of Lentivirus, which is a subgroup of retrovirus that mainly infect humans.

Over time as symptoms become worse the disease causes AIDS, which stands for acquired immunodeficiency syndrome.

AIDS is a kind of disease condition in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. Maximum cases of HIV have occured because of sexually transmitted infections such as contact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids.

According to the number of studies, in both same-sex as well as opposite-sex couples that the unprotected sexual intercourse (without condoms) is responsible for the Human Immunodeficiency Virus (HIV). Non-sexual transmission is basically responsible from an infected mother to her infant while on the pregnancy, during childbirth by exposure to her vaginal fluid or blood, and also through breastfeeding. Within all these mentioned bodily fluids, HIV exists as both free virus particles and also the virus within infected immune cells.

There are basically two types of HIV which are as follows:

• HIV-1

• HIV-2

HIV-1 is a sort of virus that was initially discovered and termed both (LAV) lymphadenopathy associated virus and (HTLV-III) human T-lymphotropic virus 3. HIV-1 is more virulent and more infective than HIV-2, and the majority of cases are due to the HIV-1.

In absence of treatment, the average survival time after infection with Human Immunodeficiency Virus (HIV) is approximately to be 9 - 11 years. This average survival time simply depends on the Human Immunodeficiency Virus (HIV)subtype.

HIV Treatments:

Aims of Treatment with the help of Antiretroviral Drugs are as follows:

The three main aims of Antiretroviral (ARV) therapy are to:

• Reduce HIV-related morbidity and mortality

• Improve prolong good quality of life

• Assist the patient in being able to return to previous work or employment

ARV Drug Classes: Antiretroviral drugs basically belong to two major classes which are as follows:

• Protease Inhibitors (PIs)

• Reverse Transcriptase Inhibitors (RTIs)

And then (RTIs) Reverse transcriptase Inhibitors are also classified into 3 groups:

• Nucleoside Reverse Transcriptase Inhibitors (NsRTIs).

• Nucleotide Reverse Transcriptase Inhibitors (NtRTIs).

• Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs).

Instances of antiretroviral drugs in each of these classes are shown as:

NsRTI:

• Zidovudine (ZDV)

• Didanosine (ddI)

• Lamivudine (3TC)

• Stavudine (d4T)

• Zalcitabine (ddC)

• Abacavir (ABC)

NtRTI:

• Tenofovir (TDF)

• Emtricitabine

NNRTI:

• Nevirapine (NVP)

• Efavirenz (EFV)

Protease Inhibitors (PI):

• Nelfinavir (NFV)

• Saquinavir (SQV)

• Ritonavir (RTV)

• Lopinavir (LPV)

• Indinavir (IDV)

• Amprenavir (APV)

All these drugs work by blocking the action of enzymes, which are important for the perspective of replication as well as functioning of the Human Immunodeficiency Virus (HIV). The medications must be used in combination, usually three drugs together.

Monotherapy basically uses one drug, is also less recommended because of the inevitable development of drug resistance. However, for the specific indication of prevention of mother to child transmission of HIV infection, short course monotherapy is still indicated

Dual nucleoside therapy is less recommended therapy due to it's less beneficial effect at a population level in terms of reducing HIV-related mortality and because dual therapy is also associated with rapid development of drug resistance.

HIV Medications:

The elaboration of most recommended antiretroviral drugs for HIV are as follows:

In order to manage the HIV/AIDS uses of multiple (ARV) antiretroviral drugs play a key role in controlling the HIV infection. There are numerous classes of ARV (antiretroviral) agents which have the potential to control different stages of HIV. This multiple drugs act differently is called highly active antiretroviral therapy (HAART). HAART helps in order to decrease the patient's total burden of HIV, it also helps in maintaining the function of the immune system.

HAART is also effective in preventing the opportunistic infections that can be cause of death.

HAART also helps in resisting the transmission of Human Immunodeficiency Virus between serodiscordant same-sex and opposite-sex partners.

Lamivudine (3TC): This is a nucleoside reverse transcriptase inhibitor. It is easy to administer and generally well tolerated.

This medication should never be taken as monotherapy as high-grade resistance rapidly develops. The drug has the potential to work effectively against hepatitis B.

The dose is 150 mg twice a day.

Side effects are infrequent and mainly consist of headaches, nausea, diarrhoea, abdominal pain and insomnia.

• As a dual therapy drug, Lamivudine is basically used in combination with Stavudine.

• As a triple therapy drug, Lamivudine is basically used in combination with Stavudine and Nevirapine.

Nevirapine (NVP): This is a non-nucleoside reverse transcriptase inhibitor. It is easy to administer. It has a long half-life.

The drug may be given as monotherapy for the prevention of mother to child transmission, but otherwise is used in combination for long term ARV therapy.

The dose is 200 mg once daily for the first two weeks, followed by 200 mg twice daily thereafter. This dose (lead dose) is essential in order to reduce the frequency of rash.

A couple of main side effects of this medication occurs during the initial 8 weeks of treatment. The first major effect is a hypersensitivity reaction (fever, rash, arthralgia, and myalgia), which can lead to a life-threatening Stevens Johnson syndrome. The second major effect is drug-induced hepatitis.

• Nevirapine may be administered on its own to pregnant women in labour and to the delivered infant within 72 hours of birth for prevention of mother to child transmission

• Nevirapine also can be used in combination with Lamivudine and Stavudine, as a triple therapy.

Lopinavir Ritonavir: Lopinavir/ritonavir (LPV/r), a fixed dose combination therapy basically sold under the brand name Kaletra.

This fixed dose combination medication is recommended for the treatment as well as prevention of HIV/AIDS. This fixed dose therapy generally combines lopinavir with a low dose of ritonavir. This combination of medications is mainly recommended in order to use with other antiretrovirals.

Both the medications known as HIV protease inhibitors. In this combination, the Ritonavir functions by slowing down the breakdown of lopinavir.

In the year of 2000, Lopinavir ritonavir was approved as a single medication for use in the United States.

Common side effects of this fixed dose combination therapy include headaches, diarrhea, vomiting, feeling tired, and muscle pains.

Darunavir-Ritonavir: In order to treat human immunodeficiency virus (HIV) infection, the combination of Darunavir ritonavir is used with some other medications.

Both the medications Darunavir and ritonavir are in a class of medications known as protease inhibitors.

Protease inhibitors mainly work by decreasing the amount of HIV in the blood.

When these two medications (darunavir and ritonavir) are combined, ritonavir helps in order to increase the amount of darunavir. So in this way the medication will have a greater effect.

Atazanavir: In the year 2003, the Atazanavir sulfate was approved for medical use, which sold under the trade name Reyataz.

Atazanavir is an antiretroviral medication which is recommended for use in order to treat and prevent HIV/AIDS. This medication should be recommended with other antiretrovirals.

The common side effects include nausea, fever, headache, yellowish skin, abdominal pain and trouble sleeping.

Entecavir: In 2005, Entecavir (ETV), was approved for medical use. The medication is basically sold under the brand name Baraclude, which is an antiviral medication commonly used in the treatment of HBV (hepatitis B virus) infection. In patients who carried both HIV/AIDS as well as HBV this antiretroviral medication should also be used.

Entecavir basically belongs to the nucleoside reverse transcriptase inhibitors (NRTIs) family of medications. It helps by preventing the HBV (hepatitis B virus) from multiplying by blocking reverse transcriptase.

The common adverse effects are headache, high blood sugar, nausea and decreased kidney function.

Atazanavir ritonavir: The combination of Atazanavir ritonavir (ATV/r) is basically used in order to treat HIV/AIDS. This is a combination of atazanavir and ritonavir. This combination of medications may be used instead of the combination of lopinavir/ritonavir.

In this combination, the function of atazanavir is as a protease inhibitor and on the other hand ritonavir functions in order to enhance the levels of atazanavir.

The most common side effects can be minimal. They may include headache, abdominal pain, yellowish skin, diarrhea and muscle pains.

Efavirenz-emtricitabine-tenofovir: In the year of 2006, the combination of Efavirenz/emtricitabine/tenofovir, was approved for medical use. The combination is basically sold under the brand name Atripla. This is a kind of medication is widely used in order to treat HIV/AIDS.

This is known as a fixed-dose combination of efavirenz, emtricitabine, and tenofovir disoproxil. This fixed dose combination should be used by itself or together with some other antiretroviral medications.

The common adverse effects include trouble sleeping, sleepiness, unsteadiness and headache.

Abacavir: Abacavir was approved for medical use. This medication basically sold under the brand name Ziagen. It is a kind of medication which is recommended for the use to prevent and treat HIV/AIDS.

Abacavir sulfate is a nucleoside analog reverse-transcriptase inhibitor (NRTIs), which should be used together with other HIV medications.

This medication is not recommended in order to use by itself.

This well tolerated medication has some common adverse effects such as fever, vomiting, trouble sleeping, and feeling tired.

Abacavir is sold together with other HIV medications, which are as:

• abacavir/lamivudine/zidovudine

• abacavir/dolutegravir/lamivudine

• and abacavir/lamivudine.

The combination of abacavir/lamivudine is also an essential medicine.

Darunavir: In the year of 2006, Darunavir (DRV) was approved for medical use in the United States.

This medication is basically sold under the brand name Prezista. This is an antiretroviral medication which is used in order to treat and prevent HIV/AIDS.

Darunavir should be recommended for use with other antiretrovirals and should be used with ritonavir (low doses) or cobicistat in order to increase darunavir effect.

The common side effects include headache, diarrhea, nausea, abdominal pain, rash and vomiting. Darunavir are available in various strength including Darunavir 800 mg, 600 mg, etc.

Read:- What are the symptoms of HIV, and how to control HIV Infection?