The human immunodeficiency virus, HIV, infects many cells of the immune system eventually leading to the development of acquired immunodeficiency syndrome, or AIDS. There is no cure for AIDS; however anti-retroviral treatment markedly reduces the disease complications of AIDS and AIDS-associated mortality.
Antiretroviral Drugs
Antiretroviral drugs prevent HIV from entering or replicating in cells of the immune system. One primary goal of antiretroviral therapy is to maximally reduce the amount of viruses in the body. To do so, antiretroviral drugs are administered in a combination of 3 or more drugs from at least 2 different classes. The combination of drugs is required because HIV can rapidly become resistant to a particular drug and the others will block further reproduction of the resistant virus. The classes of antiretroviral drugs include nucleoside and nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, fusion inhibitors, integrase inhibitors, and chemokine co-receptor inhibitors.
Treatment Guidelines
The U.S. Department of Health and Human Services, or DHHS, has developed treatment guidelines for people infected with HIV. The treatment goals are to reduce the concentration of HIV in the blood to very low or nondetectable levels, maximally suppress symptoms for as long as possible, and reduce HIV transmission.
Treatment Regimens
The DHHS has recommended three antiretroviral drug combination regimens for the treatment of adults and adolescents infected with HIV. The first is the combination of the non-nucleoside reverse transcriptase inhibitor efavirenz and the nucleotide/nucleoside reverse transcriptase inhibitors tenofovir and emtricitabine. The second regimen is based on the protease inhibitor ritonavir, boosted with either atazanavir or darunavir, in combination with tenofovir and emtricitabine. The third preferred regimen is based on the integrase inhibitor, raltegravir, which is also preferably administered with tenofovir and emtricitabine.
Treatment Adherence
Antiretroviral drug therapy requires a lifelong commitment. The DHHS states that skipping medication doses even once allows the virus to replicate more rapidly, which can lead to the development and progression of AIDS-associated complications. Additionally, nonadherence to treatment may increase the replication of drug-resistant HIV, compromising future treatment options and increasing the potential of transmission of drug-resistant HIV to others.
Treatment Benefits
The DHHS reported that combination antiretroviral therapy significantly improves the quality of life of those with HIV by decreasing the direct effects of HIV infection on the immune system and by preventing many of the indirect AIDS complications. The DHHS cited evidence that combination antiretroviral therapy that increases the levels of cells in the immune system with the protein marker CD4 may delay and prevent AIDS-associated kidney disease, liver disease, cardiovascular disease, cancers, dementia and inflammation. Additionally, the DHHS stated that treating pregnant women with combination antiretroviral therapy reduced HIV transmission to the baby from approximately 20 to 30 percent to less than 2 percent and recommended it for HIV-infected pregnant women.
