By Priyanka Anand
From PHN Issue 32, Spring 2017
This article is going to break down the types of HIV drugs, and why people living with HIV need to take medications to control the virus.
HIV and AIDS
HIV, or human immunodeficiency virus, is a virus that attacks the body’s immune system. People with weakened immune systems cannot fight infections or cancer as well, and are more likely to get sick. HIV specifically attacks a type of white blood cell called the CD4 cell.
When HIV progresses to its most severe form, it is called AIDS, or acquired immunodeficiency syndrome. People with HIV are diagnosed with AIDS when they have 200 or fewer CD4 cells, the kind of cell HIV attacks, or if they develop one of the illnesses associated with AIDS. Not everyone with HIV has AIDS.
Treatment can keep people healthy, control HIV, and prevent it from progressing to AIDS.
What is ART?
The medications that treat HIV are called antiretroviral therapy (ART).Most of these treatments interrupt the life cycle of the HIV virus, preventing it from growing in the body. The goal of ART is to reduce the viral load of HIV, which is basically the amount of HIV that is found in the blood. This helps keep the immune system strong. Blood tests for “viral load” and “CD4 count” are used to monitor a person’s response to HIV treatment.
The standard of care is to treat everyone who is living with HIV with ART, because this saves lives, reduces AIDS-related disease and other complications, and decreases HIV transmission to other people.
Even people with a strong immune system, a high CD4 count, or with no symptoms are recommended to start ART early to decrease the rate of AIDS-related disease or other complications. People with AIDS also live longer and have fewer AIDS-related complications when they take ART.
The ART regimen
Once someone is diagnosed with HIV, they will usually start on a 3-drug regimen. This usually means two nucleoside reverse transcriptase inhibitors (NRTIs) and one other type of drug, like an integrase inhibitor (INSTI), protease inhibitor (PI), or non-nucleoside reverse transcriptase inhibitor (NNRTI). Two or three medications may be combined into a single pill, so patients on a 3-drug regimen may only have to take one or two different pills.
Factors such as other health conditions, side effects, the number of pills, and cost may affect which ART medications a person uses.
Some HIV medications interact badly with other medications people are taking, so the doctor may choose not to use certain therapies for that reason. Also, some drugs should be taken with food, while others must be taken on an empty stomach.
HIV can develop resistance to medication, which is why three medications of at least two different types are used to prevent resistance. Resistance means the current ART treatment stops controlling the virus and new medications are needed.
It is important for people taking ART to take it as prescribed. Skipping doses or taking pills late runs the risk of causing treatment resistance and allowing the virus to grow again.
The doctor should get drug resistance genotype testing, which shows which medications will work for you against the HIV infection, before starting ART. Some people have HIV that is already resistant to some medications before treatment is started.
PEP and PrEP
People who do not have HIV sometimes take antiretroviral drugs to prevent HIV infection.
Post-exposure prophylaxis (PEP) means taking an antiretroviral drug after a possible exposure to HIV, like unprotected sex or needle sharing.
Pre-exposure prophylaxis (PrEP) is a pill that is taken every day by a person who may be at high risk of getting HIV, to reduce the chance of infection. Truvada, the PrEP pill, can reduce the risk of getting HIV by more than 90 percent if taken daily. People taking PrEP should get regularly tested for HIV.