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- What is antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection?
- What is HIV infection?
- How effective is ART for HIV infection?
- How does antiretroviral therapy for HIV infection work?
- What are the different types of ART for HIV infection?
- What are the DHHS guidelines for administration of ART?
What is antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection?
Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection is a treatment regimen used to reduce the amount of the virus in the body (viral load). There is no cure for HIV, but antiretroviral therapy can slow the progress of the infection and reduce the chances of transmission to others.
Many classes of HIV antiretroviral drugs act in different ways to control virus proliferation. Antiretroviral therapy usually is a combination of three or more types of medications that target the virus at different stages of its life cycle. Multiple angles of attack improve the chances of reducing the viral load.
Antiretroviral therapy is started immediately after diagnosis of HIV infection to decrease its risk of progression and transmission. HIV antiretroviral therapy regimen is tailored to suit individual requirements based on several factors that include:
- Other diseases or conditions of the patient
- Potential interactions with other medications of the patient
- Patient’s tolerance to ART side effects
- Results of viral drug-resistance tests
- Convenience of the regimen
Antiretroviral therapy is a lifelong treatment, but it can keep HIV-infected people healthy and active for many years. It is important to never stop the medication, even if the viral load drops to undetectable levels. If treatment is interrupted, the virus is more likely to mutate and become drug-resistant.
What is HIV infection?
HIV infection is caused by a virus that attacks the human immune system. Once the HIV enters the bloodstream, it binds to a kind of receptor (CD4) on the surface of the T-cells (also known as CD4 cells). T-cells are a type of white cells (lymphocytes) in the blood that help fight infection.
The virus enters the T-cell and replicates itself, destroying the host cell. As a result, the body slowly loses its ability to fight infections.
A person contracts an HIV infection by contact with bodily fluids such as blood, semen, vaginal fluids, or breast milk from an infected person. Primary modes of HIV transmission are:
- Sexual contact
- Sharing needles for injecting drugs
- From mother to the baby during pregnancy, delivery, or breastfeeding
Acquired immune deficiency syndrome (AIDS) occurs in the later stages of an HIV infection. When HIV infection progresses to an extent that a person’s immune system becomes too weak to fight off common infections, the person becomes susceptible to certain cancers and tuberculosis.
There are two main types of human immunodeficiency virus, HIV-1 and HIV-2, and each type has multiple groups and strains of virus. Both HIV infections can lead to AIDS, but they are different from each other. HIV-1 is the most common infection found worldwide and referred to as HIV. HIV-2 is found mostly in a small population in West Africa, and in a few people in the US primarily from West Africa.
How effective is ART for HIV infection?
Antiretroviral therapy has become significantly advanced with the development of new drugs and drug combinations. With the advent of highly active antiretroviral therapy (HAART), HIV-1 is now manageable as a chronic disease. Along with ART, adopting safe and healthy lifestyle habits is essential for effective management of HIV infection.
Though HIV infection cannot be completely eliminated, antiretroviral therapy can
- Control the progression of the infection
- Improve the immune system’s function
- Reduce HIV infection-related diseases and improve longevity and quality of life
- Prevent HIV transmission
How does antiretroviral therapy for HIV infection work?
Antiretroviral therapy works by preventing viral replication in the body. This allows the body’s immune system to recover. ART is a combination of drugs that act on the virus in different ways at different stages in its life cycle.
Unlike bacteria, viruses cannot multiply on their own. Viruses use the host cell’s genetic machinery to make copies of themselves. Viruses are tiny microbes consisting of just a bit of genetic material (DNA or RNA) covered with an envelope (capsid) and a protein with a sugar (glycoprotein) on the surface.
The human immunodeficiency virus is a type of RNA virus known as a retrovirus, named for a special enzyme known as reverse transcriptase. The HIV uses this enzyme to convert its RNA into DNA to fuse with the nucleus of the immune cells. The life cycle of the HIV is as follows:
- Binding: The HIV uses the glycoprotein to attach itself to the CD4 receptor on the T-cell’s surface.
- Fusion: The HIV fuses its capsid with the cell membrane and enters the T-cell.
- Reverse transcription: The HIV converts the RNA into complementary DNA (cDNA) using the reverse transcriptase enzyme, which allows it to enter the host cell’s nucleus.
- Integration: The HIV cDNA releases an enzyme known as integrase to insert itself into the T-cell’s DNA chain.
- Replication: The infected DNA makes long chains of HIV proteins which are building blocks for more HIV particles (virions).
- Assembly: The new HIV proteins and HIV RNA move to the T-cell’s surface and assemble into immature (noninfectious) HIV, while the host cell is destroyed.
- Budding: The new HIV virus that comes out of the destroyed T-cell, releases an enzyme known as protease. This enzyme breaks up the long protein chains and creates mature (infectious) viruses with a capsid and a core RNA, which disperse to infect more T-cells.
The above stages are essential for the HIV to multiply. Each drug in the antiretroviral therapy combination disrupts the HIV’s life cycle at a different stage inhibiting its growth. The HIV may mutate and develop drug resistance, in which case alternate drug combinations will be necessary.
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What are the different types of ART for HIV infection?
Antiretroviral therapy drugs are primarily divided into the following classes:
- Nucleoside reverse transcriptase inhibitors (NRTIs): Work at the reverse transcription stage by incorporation into the viral cDNA, and stop the DNA formation.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Work at the reverse transcription stage by inhibiting the release of reverse transcriptase enzyme.
- Protease inhibitors (PIs): Work at the budding stage by binding to the viral protease enzyme and prevent the maturation of the budded virus into infectious virions.
- Integrase inhibitors (INSTIs): Work at the integration stage by blocking the integrase enzyme, without which the HIV cDNA cannot insert itself into the CD4 DNA chain.
- Fusion inhibitors (FIs): Work by preventing the HIV’s fusion and entry into the CD4 or any other immune cell.
- Chemokine receptor antagonists (CCR5 antagonists): CCR5 antagonists are also fusion inhibitors which prevent certain strains of virus that enter through the CCR5 receptor, which is another receptor on the T-cell surface.
- Post-attachment entry inhibitors: These do not prevent the virus from binding to the CD4 receptor, but block further interaction and entry into the T-cell.
- Pharmacokinetic enhancers: These are drugs which enhance the performance of ART drugs by delaying their breakdown and making them remain for a longer duration in the body.
- Complete regimen combination ARTs: Antiretroviral therapy is also available in fixed dose, single pill combinations as a complete regimen for people who have difficulty taking several pills.
ART is generally initiated with two NRTIs and a drug from NNRTI, PI or INSTI class. The combination of drugs may be changed if the patient develops resistance to any of the drugs or is unable to tolerate side effects.
What are the DHHS guidelines for administration of ART?
An estimated 36.7 million people are infected with HIV worldwide, and 1.1 million in the United States. The US has about 40,000 new infections occurring each year. The US Department of Health and Human Services panel has issued guidelines to tackle the disease, based on results of clinical trials and expert opinions, which are updated on an ongoing basis.
The guidelines recommend the dosages and combination of drugs for different groups of patients such as:
Treatment-naive patients (patients who are treated for the first time)
- Treatment-experienced patients
- Regimen change for any reason
- Special groups that include the following:
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Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection is a treatment regimen used to reduce the amount of the virus in the body (viral load). There is no cure for HIV, but antiretroviral therapy given as a combination of different drugs can slow the progress of the infection and reduce the chances of transmission to others.
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Related Disease Conditions
HIV Early Signs and Stages
Human immunodeficiency virus or HIV, destroys important cells that fight disease and infection, which weakens a person's immune system. Some people with HIV don’t have any signs or symptoms. Early signs and symptoms of HIV infection include mononucleosis-like or flu-like symptoms, which include body aches, fever, and headache. Signs and symptoms begin around seven or eight years after HIV infection, which include weight loss, loss of energy and appetite, and swollen lymph nodes. There are 3 stages of HIV.
How Long Can You Live with HIV?
HIV stands for human immunodeficiency virus. If someone has HIV it means that they have been diagnosed with the HIV infection. AIDS (acquired immune deficiency syndrome); however, is the most advanced or final stage of the HIV infection. In the case of an untreated HIV infection, the overall mortality rate is more than 90%. The average time from infection to death is eight to ten years.
How Long Does It Take to See Signs of HIV?
The signs and symptoms of HIV may first appear within two to four weeks of infection. The stage in which the symptoms appear is called the stage of acute HIV infection. The symptoms appear due to the resistance or fight of the immune system against HIV. Early diagnosis and treatment of HIV gets the best results.
What Is the Difference Between HIV-1 and HIV-2?
There are two main types of the human immunodeficiency virus (HIV), HIV-1 and HIV-2. HIV-1 is the most common type of HIV and accounts for 95% of all infections, whereas HIV-2 is relatively uncommon and less infectious. HIV-2 is mainly concentrated in West Africa, is less deadly and progresses more slowly.
How Long Does It Take to Notice Signs of HIV?
HIV (human immunodeficiency virus) is a virus that attacks and damages the cells of the immune system in the body. If left untreated, HIV can lead to the AIDS (acquired immunodeficiency syndrome) disease. AIDS is the final stage of HIV infection which occurs when the body’s immune system is severely damaged because of the virus and unusual infections result. Untreated, HIV infection has a mortality of 90%.
What Are the Four Stages of HIV?
The World Health Organization (WHO) classifies human immunodeficiency virus (HIV) into four stages. Stage 1 (HIV infection): The CD4+ cell count is at least 500 cells per microliter. Stage 2 (HIV infection): The CD4+ cell count is 350 to 499. Stage 3 (advanced HIV disease or AHD): The CD4+ cell count is 200 to 349. Stage 4 (Acquired immunodeficiency syndrome [AIDS]): The CD4+ cell count is less than 200.
HIV and AIDS
Second Source article from WebMD
What Is Usually the First Sign of HIV?
Human immunodeficiency virus (HIV) attacks the cells of the immune system, leading to AIDS and death if left untreated. The first signs of the human immunodeficiency virus infection are flu-like symptoms, which mainly start around two to four weeks after getting HIV. This stage is known as acute HIV infection.
Can HIV be Cured Naturally?
HIV stands for human immunodeficiency virus. If someone has HIV it means that they have been diagnosed with the HIV infection. AIDS (acquired immune deficiency syndrome); however, is the most advanced or final stage of the HIV infection. It is important to get tested for HIV in the early stages of infection to minimize the damage to the immune system. Successful treatment aims to reduce HIV load to a level that is harmless to the body.
Human Immunodeficiency Virus (HIV)
HIV (human immunodeficiency virus) infection left untreated causes AIDS (acquired immunodeficiency syndrome). Still incurable, AIDS describes immune system collapse that opens the way for opportunistic infections and cancers to kill the patient. Early symptoms and signs of HIV infection include flu-like symptoms and fungal infections, but some people may not show any symptoms for years. Highly active antiretroviral therapy (ART) is the standard treatment for HIV infection. These combination drug regimens have made HIV much less deadly, but a cure or vaccine for the pandemic remains out of reach. HIV is usually transmitted through sexual contact or sharing IV drug needles, but can also infect someone through contact with infected blood. Sexual abstinence, safe sex practices, quitting IV drugs (or at least using clean needles), and proper safety equipment by clinicians and first responders can drastically reduce transmission rates for HIV/AIDS.
HIV vs. AIDS
Human immunodeficiency virus causes HIV infection. Acquired immunodeficiency syndrome (AIDS) is a condition that results after HIV has extensively damaged a person's immune system. Risk factors for HIV and AIDS include use of contaminated needles or syringes, unprotected sex, STDs, receiving a blood transfusion prior to 1985 in the United States, having many sex partners, and transmission from a mother to her child.
How Do You Feel When You Have HIV?
About four weeks after contracting HIV (human immunodeficiency virus), you may experience flu-like symptoms including fever, rash, sore throat, nausea, swollen glands and achy joints. You may remain symptomless for some time, however. That doesn't mean you don't need treatment; HIV can quickly progress into AIDS, in which the immune system collapses and you die of a secondary cancer or infection.
HIV/AIDS Testing: Diagnosis and Monitoring
HIV/AIDS diagnosis and monitoring have come a long way from the days when a diagnosis was a death sentence. Crucial parts of the effective treatment regimens developed in the last 40 years are consistent monitoring of the viral load (the amount of virus in the blood), and the immune cell count, which function as biological markers of the disease’s progression. Doctors also must test for drug resistance.
HIV/AIDS Facts: What Is HIV?
HIV (human immunodeficiency virus) is the precursor infection to AIDS (acquired immunodeficiency syndrome). HIV is transmitted through blood and genital secretions; most people get it through sexual contact or sharing needles for illegal IV drug use. HIV can be controlled by a strict drug regimen, but left unchecked, it leads to AIDS. In AIDS, the immune system collapses and the body falls prey to secondary, opportunistic infections and cancers that typically kill the person.
HIV/AIDS Infection Transmission and Prevention
HIV (human immunodeficiency virus) is spread through contact with genital fluids or blood of an infected person. The spread of HIV can occur when these secretions come in contact with tissues such as those lining the vagina, anal area, mouth, eyes (the mucus membranes), or with a break in the skin, such as from a cut or puncture by a needle.
HIV Medications List and Drug Charts
The ultimate goal of HIV treatment is getting the viral load down below detectable levels. As long as those viral load and antibody levels are below a proscribed range, people with HIV can stave off AIDS and other serious symptoms. Antiviral treatment options usually include combinations of two NRTIs, often referred to as "nucs," and a third drug, typically being a boosted protease inhibitor, a NNRTI, often called "non-nucs," and integrase strand transfer inhibitors.
When should you start HIV medication?
Nearly everyone who is infected with HIV (human immunodeficiency virus) should start antiviral medication therapy as soon as they are diagnosed. Older guidelines recommended delaying treatment to help reduce the potential for drug side effects and viral resistance to treatment. Current thinking theorizes that early treatment may preserve more of the body's immune function.
What Are the Side Effects of HIV Medications?
It’s important to know the potential side effects of all the drugs you take to control your HIV infection, as well as potential drug interactions. All of the NNRTIs (nonnucleoside analogue reverse transcriptase inhibitors), for example, are associated with important drug-drug interactions so they must be used with caution in patients on other medications. Learn more about the side effects of the drugs in standard treatment regimens.
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Medications & Supplements
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- Protease Inhibitors (PI Drug Class)
- Symtuza (darunavir, cobicistat, emtricitabine, and tenofovir alafenamide)
- Valcyte (valganciclovir hydrochloride)
- Dovato (dolutegravir and lamivudine)
- Stribild (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate)
- Triumeq (abacavir, dolutegravir, and lamivudine)
- Mycobutin (rifabutin)
- Prezista (darunavir)
- Trogarzo (ibalizumab-uiyk)
- Pifeltro (doravirine)
- Prezcobix (darunavir and cobicistat)
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