HIV AIDS medical therapy

Sexually transmitted diseases Main Page
AIDS Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating AIDS from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
HIV Opportunistic Infections
HIV Coinfections
HIV and Pregnancy
HIV Infection in Infants
Diagnosis
Diagnostic Study of Choice
AIDS Case Definition
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Nutrition
Drug Resistance
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies HIV Vaccine
Case Studies
Case #1
HIV AIDS medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of HIV AIDS medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on HIV AIDS medical therapy
CDC on HIV AIDS medical therapy
HIV AIDS medical therapy in the news
Blogs on HIV AIDS medical therapy
Directions to Hospitals Treating AIDS
Risk calculators and risk factors for HIV AIDS medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The primary goal of antiretroviral therapy (ART) is to reduce HIV-associated morbidity and mortality. This goal is best accomplished by using effective ART to maximally inhibit HIV replication, as defined by achieving and maintaining plasma HIV RNA (viral load) below levels detectable by commercially available assays. Durable viral suppression improves immune function and quality of life, lowers the risk of both AIDS-defining and non-AIDS-defining complications, and prolongs life. Based on emerging evidence, additional benefits of ART include a reduction in HIV-associated inflammation and possibly its associated complications.

Medical Therapy

Anti-HIV Medication

Anti-HIV medications (also called antiretrovirals) are grouped into six drug classes according to their mechanism of action. The six classes are as follows:

1. Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
2. Nucleoside reverse transcriptase inhibitors (NRTIs).
3. Protease inhibitors (PIs).
4. Fusion inhibitors.
5. CCR5 antagonists.
6. Integrase inhibitors.

Multidrug regimen has proved to be very beneficial because of reduction in progression to AIDS, opportunistic infections, rate of hospitalizations and deaths.

Goals of Therapy

DHHS ART Guidelines present the following goals for therapy:

• Durable suppression of HIV viral load ( to <50 cells/mL ).
• Restoration of normal CD4 cell count.
• Prevention of transmission of the disease.
• Prevention of building of drug resistance.
• Improvement in quality of life of the patient.

Uncontrolled viremia causes inflammation and immune activation, which has an overall effect on cardiovascular, renal and hepatic systems. Controlling viremia also controls these effects.

Anti Retroviral Therapy (ART)

▸ Click on the following categories to expand treatment regimens.

Recommended Regimens   ▸  NNRTI-Based Regimen   ▸  PI-Based Regimen   ▸  INSTI-Based Regimen Alternative Regimens   ▸  PI-Based Regimen   ▸  INSTI-Based Regimen

Recommended Regimen NNRTI-Based Regimen ▸ Efavirenz/Tenofovir/Emtricitabine† NNRTI-based regimen for patients with HIV RNA < 100,000 copies/mL ▸ Efavirenz PLUS ▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients) OR ▸ Rilpivirine/Tenofovir/Emtricitabine† (only for patients with CD4 < 200 cells/mm³) Recommended Regimen PI-Based Regimen ▸ Atazanavir/Ritonavir(low dose) PLUS ▸ Tenofovir/Emtricitabine† OR ▸ Darunavir/Ritonavir(low dose) PLUS ▸ Tenofovir/Emtricitabine† PI-based regimen for patients with HIV RNA < 100,000 copies/mL OR ▸ Atazanavir/Ritonavir(low dose) PLUS ▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients) Recommended Regimen INSTI-Based Regimen ▸ Dolutegravir PLUS ▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients) OR ▸ Dolutegravir PLUS ▸ Tenofovir/Emtricitabine† OR ▸ Elvitegravir/Cobicistat/Tenofovir/Emtricitabine†(contraindicated in patients with CrCl <70mL/min) OR ▸ Raltegravir PLUS ▸ Tenofovir/Emtricitabine† †Emtricitabine may be substituted for lamivudine or vice versa ‡ Adapted from Alternative Regimen PI-Based Regimens ▸ Darunavir/Ritonavir(low dose) PLUS ▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients) OR ▸ Lopinavir/Ritonavir(low dose) PLUS ▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients) OR ▸ Lopinavir/Ritonavir(low dose) PLUS ▸Tenofovir/Emtricitabine† Adapted from

Related Chapters

• HIV Treatment
• Antiretroviral drug
• Antiretroviral therapy in pregnancy
• Immune reconstitution inflammatory syndrome