Treatment for HIV & AIDS
While there is currently no cure for HIV or AIDS, there are various well developed medications that can help patients stay healthier and live longer lives, if they are diagnosed early and if the medications are taken properly.
The most common drugs used to treat HIV infection are called “anti-retroviral” because they fight HIV which is itself a type of “retrovirus” i. Antiretroviral drugs inhibit the growth and replication of HIV at various stages of its life cycle. With the development of new antiretroviral drugs the number of people who have been diagnosed with HIV who are alive and well continues to steadily increase. Protease Inhibitors, the new class of anti-retroviral drugs, have helped to decrease the amount of HIV virus in individuals’ immune systems allowing them to often outlive their doctor’s predictions ii. The development of antiretroviral drugs has meant that there is now the possibility to curb the effects of HIV with effective treatment.
The availability and cost of the drugs continue to prevent many of the most vulnerable people infected with the virus from accessing the medication. Presently, only one out of twenty infected persons has been able to benefit from these antiretroviral treatments iii. Unfortunately, for most people living in developing countries, this new treatment has been unattainable. In response, governments, UNAIDS, NGOs, and several pharmaceutical companies have been working to try and overcome these challenges by addressing the issue of high costs and inadequate healthcare services as well as the issue of increasing supply, improving accessibility, and distribution iv.
What are the goals of antiretroviral treatment? v :
- To ensure maximum and lasting control of the amount of HIV in the blood of an HIV-positive person.
- To restore and preserve the normal functioning of the immune system.
- To improve the quality of life of people infected with the virus.
- To reduce morbidity (i.e. the occurrence of opportunistic infections and number of hospitalizations) as well as death.
What are the different types of antiretroviral drugs?
There are currently four types of FDA-approved antiretroviral medications used to treat HIV and AIDS; these are vi :
- Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
- Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
- Protease Inhibitors
- Fusion Inhibitors (i.e. also referred to Entry Inhibitors)
How do these antiretroviral drugs work?
Antiretroviral drugs work to inhibit the growth and replication of HIV at various stages of its life cycle. NRTIs, the first type of antiretroviral drugs, work to interrupt the virus at an early stage of the replication process (i.e. it works to limit the virus from reproducing itself). NRTIs help to slow down the spread of HIV in the body, while they also delay the start of other opportunistic infections that might occur as a result of a weakened immune system. NNRTIs, a second type of antiretroviral drug, help the enzyme called “reverse transcriptase” from working so that viral cells cannot reproduce. Thirdly, Protease Inhibitors work to interrupt virus replication at the later stage of the HIV life cycle. Finally, Fusion Inhibitors bind to the HIV virus cells and prevent the virus from infecting the healthy cells in the body vii.
What are some things you should know before starting treatment?
There are several decisions that you will need to take once you have been diagnosed with HIV and therefore it is crucial that you are able to discuss your treatment options with your doctor before starting treatment. There are two crucial points that one must consider before beginning treatment: these are the concepts of adherence and drug resistance. It is crucial that once the avenue of treatment is decided that the patient ensures that he or she adheres to and appropriately follows the directions the medication must be taken under. This is a crucial part of the treatment process since some antiretroviral drugs must be taken at specific times of the day, with or without certain kinds of food etc. Since a person who is HIV-positive will be taking these drugs for a long period of time, possibly for the rest of their lives, it is crucial that their combination of drugs works with their schedule and lifestyle viii. Furthermore, the problem of drug resistance must also be considered before beginning the treatment process. When an anti-HIV therapy is failing often because it is not taken properly, the virus can begin to mutate, making the drug ineffective until it stops working all together. This is known as drug resistance. Therefore it is crucial that all antiretroviral drugs be taken consistently to ensure that the HIV and AIDS virus doesn’t become resistant to the medication.
Is there a difference between antiretroviral drugs and highly active antiretroviral drugs (HAART)?
Antiretroviral drugs are the medications used to treat HIV. There are different classes of antiretroviral drugs that act at different stages of the HIV life cycle. Highly Active Anti-retroviral Drugs (HAART) are no different than antiretroviral drugs; they are simply referred to as highly active because they are a combination of antiretroviral drugs (typically three or four different kinds) used to combat HIV. HAART is also often referred to as combination therapy.
Combination therapy combines protease inhibitors (drugs that block a part of HIV called protease, allowing HIV to make copies of itself that cannot infect new cells ix ) with older antiretroviral drugs to help reduce the amount of HIV in the body. These drugs work together to attack the virus at different stages in the replication process x. Combination therapy (aka HAART) also appears to help the drugs remain effective for longer periods of time, reducing the likelihood of people developing resistance.