HIV AIDS medical therapy

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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.

Group	Drugs	Dosing
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)	Abacavir (ABC)	300 mg BID or 600 mg/d
	Didanosine (ddI)	400 mg/d In combination with TDF: 200 mg/day
	Emtricitabine (FTC)	200 mg/d
	Lamivudine (3TC)	150 mg BID or 300 mg/d
	Stavudine (d4T)	400 mg BID
	Tenofovir Disoproxil Fumarate (TDF)	300 mg/d
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)	Efavirenz(EFV)	600 mg/d
	Etravirine (ETR)	200 mg BID
	Nevirapine (NVP)	200 mg/d for 14 days, then 200 mg BID or 400 mg/d
	Rilpivirine (RPV)	25 mg/d
Protease Inhibitors (PIs)
	Atazanavir (ATV)	400 mg/d In combination with TDF: 300 mg/d + RTV 100 mg/d In combination with EFV: 400 mg/d + RTV 100 mg/d

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) †Emtricitabine may be substituted for lamivudine or vice versa Adapted from Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 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) †Emtricitabine may be substituted for lamivudine or vice versa Adapted from Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 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 Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 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† †Emtricitabine may be substituted for lamivudine or vice versa Adapted from Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Alternative Regimen INSTI-Based Regimens ▸ Raltegravir PLUS ▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients) †Emtricitabine may be substituted for lamivudine or vice versa Adapted from Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.

Related Chapters

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