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    HIV: Antiretroviral Therapy (ART) – Health Information Library

    Antiretroviral therapy (ART) is the combination of several antiretroviral medicines used to slow the rate at which HIV makes copies of itself (multiplies) in the body. A combination of three or more antiretroviral medicines is more effective than using just one medicine (monotherapy) to treat HIV. The use of three or...

    HIV: Antiretroviral Therapy (ART)

    HIV: Antiretroviral Therapy (ART) Overview

    Antiretroviral therapy (ART) is the combination of several antiretroviral medicines used to slow the rate at which HIV makes copies of itself (multiplies) in the body. A combination of three or more antiretroviral medicines is more effective than using just one medicine (monotherapy) to treat HIV.

    The use of three or more antiretroviral medicines—sometimes referred to as an anti-HIV "cocktail"—is currently the standard treatment for HIV infection. So far, this treatment offers the best chance of preventing HIV from multiplying, which allows your immune system to stay healthy. The goal of antiretroviral therapy is to reduce the amount of virus in your body (viral load) to a level that can no longer be detected with current blood tests.

    Antiretroviral medicines that are often used to treat HIV include:

    Nucleoside/nucleotide reverse transcriptase inhibitors, also called nucleoside analogs, such as abacavir, emtricitabine, and tenofovir. These medicines are often combined for best results.

    Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz, etravirine, and nevirapine.

    Protease inhibitors (PIs), such as atazanavir, darunavir, and ritonavir.

    Entry inhibitors, such as enfuvirtide and maraviroc.

    Integrase inhibitors, such as dolutegravir and raltegravir.

    Some medicines are available combined together in one pill. This reduces the number of pills to be taken each day.

    The U.S. National Institutes of Health recommends using one of the following programs for people who begin treatment for HIV:

    footnote 1

    Dolutegravir + abacavir + lamivudine

    Dolutegravir + tenofovir + emtricitabine

    Elvitegravir + cobicistat + tenofovir + emtricitabine

    Raltegravir + tenofovir + emtricitabine

    Ritonavir-boosted darunavir + tenofovir + emtricitabine

    Other drug combinations are approved and may be used in some cases.

    Also, studies have shown that if you are not infected with HIV, taking antiretroviral medicines can protect you against HIV.

    footnote 2, footnote

    3 But to keep your risk low, you still need to use safer sex practices.

    Related Information

    Current as of: February 9, 2022

    Author: Healthwise Staff

    Medical Review:E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Peter Shalit MD, PhD - Internal Medicine

    स्रोत : www.peacehealth.org

    ART for HIV: Understanding Antiretroviral Therapy

    Also known as the “AIDS cocktail,” antiretroviral therapy (ART) is a combination of antiretroviral drugs. This treatment has been highly effective in delaying the progression of HIV. Find out what types of drugs are in this therapy, how it works, and how it can benefit people living with HIV.

    Understanding ART for HIV

    Medically reviewed by Alan Carter, Pharm.D. — By Julie Verville — Updated on December 23, 2019

    About ART

    Shortly following the discovery of HIV in 1981, a variety of therapies using one drug were introduced to people living with HIV. This included the drug azidothymidine (AZT).

    Despite initial success, these “monotherapies” proved to be ineffective in slowing the progression of the virus.

    This failure was due to HIV’s ability to quickly develop resistance to these single-drug treatments. In other words, HIV mutated (changed) into a form that no longer responded to the individual drugs.

    In 1995, a combination drug treatment known as the “AIDS cocktail” was introduced. This type of therapy was originally known as highly active antiretroviral therapy (HAART). It’s also called combination antiretroviral therapy (cART) or simply antiretroviral therapy (ART).

    Regardless of its name, ART has led to dramatic improvements in people who have used it. People have experienced decreased viral loads (the amount of HIV in their body) and increased counts of CD4 cells (immune cells that are destroyed by HIV).

    According to the Centers for Disease Control and Prevention

    Trusted Source Trusted Source

    , people who take antiretroviral therapy as prescribed and maintain an undetectable viral load have “effectively no risk” of transmitting HIV to others.

    In addition, life expectancies have become much closer to typical life expectancies. One of the main reasons for ART’s success is that it helps prevent resistance to any single drug used.

    Read on to learn more about the life-changing treatment called ART.

    Combination antiretroviral therapy drug regimen classes

    A variety of ART drug therapies are currently available by prescription. Each drug included in the combination therapy serves a unique purpose, but together they work to accomplish several important goals:

    Prevent the virus from replicating and reduce viral load.

    Help restore CD4 counts and immune function.

    Reduce complications from HIV and improve survival.

    Reduce transmission of HIV to others.

    The current classes of drugs included in antiretroviral therapies include:

    Nucleoside reverse transcriptase inhibitors (NRTIs). HIV requires an enzyme called reverse transcriptase (RT) in order to replicate. By offering faulty versions of RT to the virus, NRTIs block HIV’s ability to replicate.Non-nucleoside reverse transcription inhibitors (NNRTIs). These inhibitors disable a key protein that HIV requires to replicate.Protease inhibitors (PIs). This inhibitor disables the protein called protease, another key building block required by HIV to replicate.Entry or fusion inhibitors. These inhibitors block the virus’s ability to enter the body’s CD4 cells.Integrase inhibitors (INSTIs). Once HIV has penetrated a CD4 cell, it inserts genetic material into the cells with the assistance of a protein called integrase. These inhibitors block the virus’s ability to complete this crucial replication step.

    Current recommended HIV treatment protocols

    According to the National Institutes of Health, the current recommendations for an initial HIV drug regimen include three HIV medications from two or more different drug classes.

    Typically, this includes:

    two NRTIs with an INSTI, NNRTI, or PI

    ritonavir or cobicistat as a booster

    Once a regimen is put into place, a healthcare provider will carefully monitor ongoing reaction and success levels. If the person has severe side effects or if the regimen doesn’t work, the healthcare provider can make changes to the drug regimen.

    Antiretroviral treatment is currently recommended for all people living with HIV. However, certain situations make receiving treatment more urgent.

    Examples of these situations involve people who:

    are currently pregnant

    have previously experienced HIV-related dementia, cancer, or other HIV-related complications such as infections or nerve pain

    have hepatitis B or hepatitis C

    have had CD4 counts below 200 cells/mm3

    Once an antiretroviral treatment is started, it should be continued long term. This helps maintain a low viral load and a normal CD4 count.

    The takeaway

    The introduction of ART changed everything about HIV treatment and prevention. It has brought a sense of renewed hope for increased longevity in people living with HIV.

    In addition, it’s provided significant improvements in the overall quality of life for people living with HIV.

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    Last medically reviewed on May 10, 2019

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    स्रोत : www.healthline.com

    Three

    Three-drug combination found most effective in treating HIV infection

    By MITZI BAKER

    In the largest comparison of highly active AIDS treatments involving multiple drugs given together, one specific combination proved to be the most effective way to combat HIV, the virus that causes AIDS.

    The study, co-led by researchers at the Stanford School of Medicine and Massachusetts General Hospital, evaluated several drug regimens involving either three or four of the 19 HIV drugs currently available.

    One three-drug combination proved to be significantly more effective at keeping the virus at bay than the other triple-drug regimens and, surprisingly, worked as well as the four-drug combinations. The findings were published in two papers last month in the

    "One three-drug regimen turned out to be so good that we couldn’t show that adding another drug was better," said Robert Shafer, MD, assistant professor of medicine, who was first author of the study that looked at four-drug combinations. Overall, he said, all the drugs turned out to work better than expected when the study began in 1998.

    "Because of these results, it is clear that we should now be expecting starting regimens to be completely effective at suppressing virus unless there are problems in terms of patient adherence to the regimen or a patient can’t tolerate the drugs or has problems purchasing the drugs because of financial hardships or accessibility," Shafer said, "Failure should be the absolute exception, not the expectation."

    The use of several anti-HIV drugs in combination has transformed HIV from a stark death sentence into something more manageable. The use of several drugs, each attacking HIV through a different vulnerability, helps prevent resistance that inevitably occurs over time with single-drug use. Prompt treatment with an effective drug combination can attack HIV while the virus is still vulnerable and before it takes its toll on the immune system, said Shafer.

    While it was obvious that multiple drugs fight HIV better than any alone, no one knew if how they were combined made a difference. The team designed two studies to address this question involving nearly 1,000 patients followed for more than three years at 81 sites in the United States and Italy.

    With the three-drug study, there was a dramatic answer: One combination prevented the virus from rebounding in 90 percent of patients, compared to 60 to 70 percent of patients given one of the other three combinations tested.

    The cocktail that worked best included the oldest HIV drug, AZT; Epivir, known as 3TC; and efavirenz, sold under the brand name Sustiva.

    The four-drug study — led by Shafer and Thomas Merigan, MD, the George E. and Lucy Becker Professor of Medicine — asked whether using an additional drug might potentially work even better. It also questioned whether the combination might be more toxic, in addition to being more expensive and more difficult to follow than a three-drug regimen.

    After an average of 28 months, an intriguing finding came to light: The two four-drug regimens were more effective at preventing failure of the initial treatment regimen than each of the three-drug regimens except the triple-drug combination that worked best in the three-drug study. Upon further analysis, this same triple-drug regimen led to faster suppression of the virus than the two four-drug regimens.

    In both studies, participants who began treatment with two specific drugs — the combination of didanosine and stavudine — had more drug toxicity problems, such as nerve damage and pancreatic inflammation. Shafer said this is the first time the toxic effects of these drugs have been followed in a large study of previously untreated patients.

    This result led researchers to recommend that treatment of HIV infection should not begin with these two drugs, a stand that has been incorporated into federal treatment guidelines.

    "A wall has been reached," said Shafer. "We have drugs that are so effective now that it will be hard to show in the future that another regimen will be more effective. We are now going to have to evaluate drug regimens based on factors like their tolerability, cost and availability." The goal for future treatments, he said, is to have even less toxicity, greater ease of adherence and lower cost.

    The study was funded by the AIDS Clinical Trial Group Program, sponsored by the National Institute of Allergy and Infectious Diseases, the National Center for Research Resources, and the HIV Clinical Research Programme.

    स्रोत : news.stanford.edu

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