How Many HIV Treatments Are There? 7 HIV Drug Classes

1. Nucleoside reverse transcriptase inhibitors (NRTIs):
   1. These medications inhibit reverse transcriptase, an enzyme required by the virus to produce new viruses. 
   2. NRTIs prevent the creation of new viruses by inserting themselves into the virus' DNA when it attempts to replicate itself. 
   3. The first class of HIV medicines were NRTIs. An initial highly active antiretroviral therapy (HAART) regimen will typically be made up of two of these medications.
2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs):
   1. These medications bind to reverse transcriptase and alter the enzyme so that it no longer functions.
   2. An NNRTI may be used as the third medication in an initial HAART regimen.
3. Protease inhibitors (PIs):
   1. These medications inhibit protease, another enzyme required by the virus for replication. 
   2. PIs can be used as part of the first HAART regimen.
   3. They do, however, require the inclusion of a pharmacokinetic enhancer, which is a medication that amplifies the effects of PIs on HIV.
4. Integrase strand transfer inhibitors (INSTIs):
   1. These medications stop HIV from replicating. 
   2. To reproduce, HIV inserts its DNA into the DNA of CD4 cells. Integrase inhibitors suppress the HIV enzyme that facilitates the transmission. 
   3. INSTIs can be used as the third medication in an initial HAART regimen.
5. Entry inhibitors or chemokine coreceptor antagonists (CCR5s):
   1. These medications prevent the virus from entering the cell by blocking CCR5, a protein on the surface of CD4 cells. This keeps the infection from infiltrating. 
   2. This protein is only found in specific strains of HIV. A blood test can inform your doctor whether your HIV strand will respond to this drug class.
6. Fusion inhibitors:
   1. These medications keep HIV from fusing with the cell membrane of CD4 cells, thus preventing the virus from infiltrating the cell. 
   2. These are not currently recommended as first-line therapy. They are instead an option for treatment-experienced individuals who need to switch regimens.
7. Pharmacokinetic enhancers:
   1. These medications improve the efficacy of other medications. 
   2. They achieve this by interfering with the breakdown of other drugs, which increases the amount of the drug in blood levels.

Important factors in HIV treatment include the following:

Adherence

When you start therapy, you must take your medications on time. This is referred to as adherence. Adherence is essential for getting the most out of HIV medications because the drugs must be kept at certain levels in your body in order to combat the infection. If the drug level lowers, HIV may have an opportunity to fight back. 

Skipping doses, not taking medications on time, and failing to follow meal requirements can all cause your drugs to be less effective or to stop working entirely.

Resistance

You should witness a drop in viral load and an increase in CD4 cells after starting HIV medications. However, some people's viral loads grow with time, even as they continue to take HIV medications. When a medicine can no longer successfully fight HIV, it has become resistant to that drug. 

If you develop resistance, you will almost certainly need to modify some of the medications in your regimen  If your viral load increases while you are still taking HIV medications, your doctor should offer you a resistance test to determine which treatments aren't working and to help you pick ones that will. 

It may be difficult to identify a treatment for certain people who have developed resistance to multiple HIV medications. The best strategy to combat resistance is to stick to your treatment schedule.

Side effects of HIV medications may vary from one drug to the next and from one person to the next. Common side effects of HIV treatment include:

• Headache
• Muscle pain 
• Joint discomfort
• Diarrhea
• Nausea
• Disorientation
• Vivid nightmares
• Organ damage to the kidneys, liver, pancreas, and bone marrow.

Side effects of HIV drugs and HIV infection itself can occasionally increase the risk of cardiovascular disease and diabetes. Routine checkups are thus required, both to monitor the action of the drug and to identify any side effects. Treatment of illnesses other than HIV may have side effects that increase or decrease the efficacy of HIV medication.

Although there is no cure for HIV, the infection can be effectively managed with medication. People with HIV are treated with antiretroviral therapy (ART), which is highly efficient in lowering the quantity of virus in the blood to undetectable levels. People who use ART live a healthy life without the danger of sexually transferring the virus to their partners. 

Pre-exposure prophylaxis and post-exposure prophylaxis drugs are particularly efficient in preventing HIV transmission in HIV-negative people.

Advantages of HIV treatments

• Antiretroviral therapy (ART) prevents HIV from replicating in the body, which helps protect the immune system.
• For many people, ART can repair the immune system damage caused by HIV.
• ART reduces the risk of chronic HIV-related heart disease, cancer, renal disease. and other long-term health concerns.
• HIV increases the long-term risk of health problems such as heart disease, renal disease, and cancer. Keeping HIV suppressed helps reduce the risk of these diseases
• HIV treatment lowers the quantity of detectable virus in blood and sexual fluids, thus lowering the risk of transmission to others.
• ART can increase life expectancy.

Disadvantages of HIV treatments

• HIV or acquired immunodeficiency syndrome cannot be cured with ART.
• If an HIV-positive individual discontinues ART, the virus will begin replicating in the body again, and virus levels will increase and they will be infectious.
• ART can minimize the danger of transmission, but it is not known if it can entirely remove the risk of HIV transmission to others.
• In rare cases, ART for people with HIV will not alleviate symptoms. 
• An HIV-infected individual who is feeling well and does not have HIV symptoms may feel worse on ART due to side effects such as nausea or headaches.
• Nonetheless, it is crucial to remember that ART offers significant long-term benefits for an HIV-positive person's health, even if they are not suffering symptoms initially.

Some doctors believe that starting therapy sooner with a CD4 count more than 350 and no symptoms is a good idea. There are benefits and risks to doing so:

Benefits

• Maintaining a better CD4 cell count
• Preventing future immune system damage
• Reducing the risk of HIV and non-HIV health issues
• Lowering your risk of spreading HIV to others

Risks

• Experiencing drug-related adverse effects, including unknown long-term ill effects
• Drug resistance that may limit future treatment options
• Having to stay on therapy for a longer period

If you have been exposed to HIV, talk to your doctor about treatment options for you.

Based on current limitations in HIV therapy, scientists are investigating different approaches that may inhibit or cure HIV. Advancements in HIV treatments include:

• Long-lasting HIV medications:
  • Given the tremendous improvement in HIV care provided by antiretroviral therapy (ART), current research focuses on producing antiretroviral medications with long-term benefits. 
  • In contrast to current existing pharmaceuticals that require daily administration, future long-lasting treatments are projected to require weekly, monthly, or even less frequent dosing.
  • Long-term ART can take several forms, such as tablets, injections, patches, or implants. 
  • Furthermore, because such formulations are likely to have fewer side effects, they are expected to enhance treatment adherence and minimize treatment-related expenses.
• Neutralizing antibodies:
  • Another significant strategy is to create broadly neutralizing antibodies that can help with HIV treatment in a variety of ways.
  • These antibodies can directly attach to viruses and block them from entering cells, enhancing the rate of viral eradication.
  • Furthermore, they can stimulate an immunological response in HIV-infected cells, ensuring viral eradication. 
  • Most crucially, by attaching to a critical viral component, the antibody can create a complex that can induce an immune response comparable to vaccination, thus aiding in the development of protection against future viral encounters. 
  • Studies have reported that a combination of complementary antibodies can successfully suppress HIV infection for an extended length of time.
• Vaccination:
  • Although no vaccine exists to prevent HIV infection, researchers are working on therapeutic vaccinations that can be given to people who are already infected.
  • These vaccinations prepare the body for long-term management of HIV infection by activating the immune system.
  • A dual vaccination strategy has been devised, in which one vaccine targets the reservoir, whereas the other stimulates the production of antibodies that limit viral reproduction.
• HIV immunotherapy:
  • Another important strategy involves drug-mediated viral reservoir activation and vaccine-mediated generation of an HIV-specific strong immune response. 
  • In this regard, the vaccination that induces antibody formation against the HIV protein 3S, which primes T cells to identify and destroy the virus more effectively, is the most promising.
• New drugs:
  • In addition, new medications for daily ART are being developed. Nucleoside reverse transcriptase translocation inhibitors (inhibit HIV reverse transcriptase and impede DNA synthesis) and maturation inhibitors (halt viral maturation by targeting HIV lifecycle) are two medications under research.
  • Furthermore, medications that bind to the viral surface protein (gp120) to prevent virus-mediated immune cell infection, as well as pharmaceuticals that block capsid (protein shell that covers the viral DNA), are being researched.
  • The discovery of medications that can block viral replication by binding to a particular RNA sequence of the virus is the most promising. The primary purpose of this strategy is to target the latent HIV reservoir within the cells.
  • Another key technique is to create medications that first activate the latent viral reservoir before eradicating the virus with standard ART.
• Gene editing:
  • Another possibility is to insert a particular mutation into the human DNA that renders them immune to HIV infection. 
  • This mutation is found in about 1% of the world's population who are naturally resistant to HIV.
  • This genetic mutation results in the creation of a structurally different immune cell surface protein (CCR5) than the wild-type protein. 
  • The virus is unable to connect to the changed protein, making it difficult for the virus to enter and infect the immune cell.
  • Such alterations will be considerably easier to introduce in the future thanks to the CRISPR-Cas9 gene-editing technique.