Treatment and Clinical management

Antiretroviral medications are used to control the reproduction of the HIV virus and slow progression of HIV-related disease. Highly Active Antiretroviral Therapy (HAART) is the treatment protocol that is recommended for HIV infection. HAART combines 3 or more antiretroviral medications in a daily regimen. The exact medication regimen is highly individualized, depending upon many factors. Usually taking only 1 or 2 medications is not effective. Unless the individual is taking 3 or more medications, the decrease in viral load tends to be temporary. Treatment involves a number of considerations:

Antiretroviral medications Adjustments to treatment Non-occupational post-exposure prophylaxis (nPEP) Treatment during pregnancy Side effects of treatment
Antiretroviral medications
There are 4 classes of antiretroviral medication used in the treatment of HIV.
Class
Generic name
Brand name
Nonucleoside Reverse Transcriptase Inhibitors (NNRTIs) bind to and disable reverse transcriptase, a protein that HIV needs to replicate.
Delavirdine
Rescriptor, DLV
Efavirenz
Sustiva, EFV
Nevirapine
Viramune, NVP

Nuceleoside Reverse Transcriptase Inhibitors (NRTIs) are faulty versions of building blocks that HIV needs to replicate. When HIV uses an NRTI instead of a normal building block, reproduction of the virus is stalled.
Abacavir
Ziagen, ABC
Abacavir Lamivudine
Epzicom
Abacavir,Lamivudine,Zidovudine
Trizivir
Didanosine
Videx, ddI, Videx EC
Emtricitabine
Emtriva, FTC, Coviracil
Emtricitabine, Tenofovir DF
Truvada
Lamivudine
Epivir, 3TC
Lamivudine, Zidovudine
Combivir
Stavudine
Zerit, d4T
Tenofovir DF
Viread, TDF
Zalcitabine
Hivid, ddC
Zidovudine
Retrovir, AZT, ZDV
Protease Inhibitors (PIs) disable protease, a protein that HIV needs to replicate.
Amprenavir
Agenerase, APV
Atazanavir
Reyataz, ATV
Fosamprenavir
Lexiva, FPV
Indinavir
Crixivan, IDV
Lopinavir, Ritonavir
Kaletra,LPV/r
Nelfinavir
Viracept, NFV
Fusion Inhibitors function by blocking HIV entry into cells.
Enfuvirtide
Fuzeon, T-20
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One or two anti-retroviral medications are usually sufficient to decrease viral load.
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Adjustments to Treatment
People who are receiving antiretroviral medications should have a baseline viral load and CD4 count done and regular evaluations during treatments. If the viral load increases and CD4 count decreases, the treatment regimen may need to be adjusted. In that case, the physician will evaluate 3 factors to determine what adjustments need to be made:
· Adherence: Refers to how closely a person follows the medication regimen. If someone is unable to follow the regimen, treatment may need to be adjusted to give medication in fewer doses or fewer pills.
· Tolerability: Refers to side effects caused by the medications. If a particular drug is causing a very difficult side effect, a different medication may be prescribed. Medication interactions: Refers to drug reactions to other medicines a person may be taking. Since some drug reactions can have a negative effect on the efficacy of antiretroviral treatment, these reactions need to be identified, so treatment can be adjusted.