Treating HIV/AIDS

HIV is managed with anti-retroviral therapies to reduce the HIV viral load in a patients body. There is no cure as of yet for HIV, and the current hope in HIV treatment is to slow the progression of destruction to the immune system wracked by the virus.

There are a few different types of anti-retroviral therapies which are in widespread use, and the different types are often used together to increase the effectiveness of the treatment.

Anti-retroviral treatments

1. nucleoside reverse transcriptase inhibitors (NRTIs)
   • interrupt HIV from making copies of itself at an early stage in the replication process
   • includes drugs such as:
     • lamivudine (3TC)
       • brand names: Epivir, Epivir HBV
     • abacavir
       • brand names: Ziagen
     • zidovudine (AZT)
       • brand names: Retrovir
     • stavudine (d4T)
       • brand names: Zerit, Zerit XR
     • zalcitabine (ddC)
       • brand names: Hivid
     • didanosine (ddI)
       • brand names: Videx, Videx EC
     • tenofovir
       • brand names: Viread
2. non-nucleoside reverse transcriptase inhibitors (NNRTIs)
   • function in a manner similar to NRTIs, slow the virus from multiplying in the body
   • administered in combination with other anti-retroviral treatments
   • includes drugs such as:
     • delaviridine
       • brand names: Rescriptor
     • nevirapine
       • brand names: Viramune
     • efavirenz
       • brand names: Sustiva
3. protesase inhibitors
   • interrupt HIV from making copies of itself at a later stage in the replication process
   • includes drugs such as:
     • ritonavir
       • brand names: Norvir, Norvir Soft Gelatin
     • saquinavir
       • brand names: Invirase, Fortovase
     • indinavir
       • brand names: Crixivan
     • amprenavir
       • brand names: Agenerase
     • nelfinavir
       • brand names: Viracept
     • lopinavir
       • brand names: Kaletra

Highly Active Anti-retroviral Treatment (HAART)

HIV in the body can become resistant to drugs over the course of treatment, therefore it is necessary for treatment providers to use the drugs in combination to effectively suppress the virus from multiplying. Highly Active Anti-retroviral Treatment (HAART) refers to when reverse transcriptase and protease inhibitors are used in conjunction as a treatment option. HAART is in widespread use and has been successful in keeping HIV viral loads to a minimum (e.g. to nearly undetectable levels) in patients receiving the treatment.

There still remains no cure for HIV/AIDS, and HAART is no exception to this rule: the virus does remain in the lymph nodes, brain, reproductive organs, eyes, and other body tissues of people receiving HAART. HAART has helped many people with HIV manage the disease, but it does not come without its side effects, some of which can be quite serious.

Some NRTIs can decrease the levels of red and white blood cells, especially in the later stages of HIV infection, as well as inflammation of the pancreas and nerve pain. Other complications and reactions to nucleoside can occur during HAART, even death. Patients receiving HAART treatment are recommended to be followed closely by their health care provider. Protease inhibitors can have adverse interactions with other drugs and are associated with common side effects of nausea, diarrhea, and other gastrointestinal problems.

Treating opportunistic infections

Pneumocystic Carinii Pneumonia (PCP) is likely the most common and lethal opportunistic infection among HIV/AIDS patients. In addition to anti-retroviral treatments, patients whose T-cell counts drop below 200 are given a regime of PCP drugs to prevent the occurrence or re-occurrence of PCP. Common PCP drugs are sulfamethoxazole (SMX) and trimethoprim (TMP) or pentamidine.

People with HIV/AIDS are much more prone to yeast and fungal infections. Since the immune system is compromised by HIV infection, the body cannot fight off infectious fungi. Fungal infections in HIV-positive persons can arise in the mouth, throat, genitals, and lungs. Fluconazole is an anti-fungal drug often used for treating fungal infections in HIV/AIDS patients.

Cytomegalovirus (CMV) retinitis (eye infection) is also commonly reported among HIV/AIDS patients. Treatment providers will typically use foscarnet and ganciclovir (both anti-virals) to treat CMV eye infections.