Treatments for HIV/AIDS

Treatment list for HIV/AIDS: The list of treatments mentioned in various sources for HIV/AIDS includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Nucleoside reverse transcriptase (RT) inhibitors - also called nucleoside analogs
- Zidovudine (AZT) - also called ZDV
- Zalcitibine (ddC)
- Didanosine (ddI)
- Stavudine (d4T)
- 3TC (lamivudine)
- Abacavir
- Tenofovir
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) - usually in combination with other antiretroviral drugs.
- Delvaridine (Rescriptor)
- Nevirapine (Viramune)
- Efravirenz (Sustiva)
Protease inhibitors
- Ritonavir (Norvir)
- Saquinivir (Invirase)
- Indinavir (Crixivan)
- Amprenivir (Agenerase)
- Nelfinavir (Viracept)
- Lopinavir (Kaletra)
Combination drug treatments - because HIV becomes drug resistent, it is typical to use a combination of drugs.
Highly active antiretroviral therapy (HAART) - a treatment strategy of aggressive use of medications.
Treatments for opportunistic infections
- Foscarnet - for CMV eye infections
- Ganciclovir - for CMV eye infections
- Fluconazole - for fungal infections
- Trimethoprim/sulfamethoxazole (TMP/SMX) - for PCP
- Pentamidine - for PCP
Treatments for complications - each complication needs its own treatment.
Treatments to prevent mother-infant transmission include:
- AZT
- Antiviral agents
- Multidrug combinations
- Nevirapine

Treatment of HIV/AIDS: medical news summaries: The following medical news items are relevant to treatment of HIV/AIDS:

Treatments of HIV/AIDS discussion: There is no cure for AIDS but recently developed, experimental treatments appear very promising. Some symptoms and complications may improve with treatment. For example, antidementia drugs may relieve confusion and slow mental decline. Infections may be treated with antibiotics. Radiation therapy may be needed to treat AIDS-related cancers present in the brain or spinal cord. Drug "cocktails" recommended to treat AIDS can cause neuropathy. Neurological complications of AIDS are often underrecognized by AIDS clinicians, so patients who suspect they are having neurological complications should be sure to discuss these with their doctor. ¹

NIAID investigators are defining the best treatments for pediatric patients. Currently there are 16 drug products approved by the FDA for the treatment of adult HIV infection. Through major contributions by the Pediatric ACTG, 10 antiretroviral agents have pediatric label information, including 3 protease inhibitors.²⁸ While the basic principles that guide treatment of pediatric HIV infection are the same as for any HIV-infected person, there are a number of unique scientific and medical concerns that are important to consider in the treatment of children with HIV infection. These range from differences from adults in age-related issues such as CD4 lymphocyte counts and drug metabolism to requirements for special formulations and treatment regimens that are appropriate for infants through adolescents. As in adults, treatment of HIV-infected children today is a complex task of using potent combinations of antiretroviral agents to maximally suppress viral replication. ²

When AIDS first surfaced in the United States, there were no medicines to combat the underlying immune deficiency and few treatments existed for the opportunistic diseases that resulted. Over the past 10 years, however, researchers have developed drugs to fight both HIV infection and its associated infections and cancers.

The U.S. Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. Included in this class of drugs (called nucleoside analogs) are AZT (also known as zidovudine or ZDV), ddC (zalcitabine), ddI (dideoxyinosine), d4T (stavudine), and 3TC (lamivudine). These drugs may slow the spread of HIV in the body and delay the onset of opportunistic infections.

Health care providers can prescribe non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as delvaridine (Rescriptor), nevirapine (Viramune), and efravirenz (Sustiva), in combination with other antiretroviral drugs.

More recently, FDA has approved a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt virus replication at a later step in its life cycle. They include

ritonavir (Norvir)
saquinivir (Invirase)
indinavir (Crixivan)
amprenivir (Agenerase)
nelfinavir (Viracept)
lopinavir (Kaletra)

Because HIV can become resistant to any of these drugs, health care providers must use a combination treatment to effectively suppress the virus.

Currently available antiretroviral drugs do not cure people of HIV infection or AIDS, however, and they all have side effects that can be severe. Some of the nucleoside RT inhibitors may cause a depletion of red or white blood cells, especially when taken in the later stages of the disease. Some may also cause an inflammation of the pancreas and painful nerve damage. There have been reports or complications and other severe reactions, including death, to some of the antiretroviral nucleoside analogs when used alone or in combination. Therefore, health care experts recommend that people on antiretroviral therapy be routinely seen and followed by their providers.

The most common side effects associated with protease inhibitors include nausea, diarrhea, and other gastrointestinal symptoms. In addition, protease inhibitors can interact with other drugs resulting in serious side effects.

Researchers have credited highly active antiretroviral therapy, or HAART, as being a major factor in reducing the number of deaths from AIDS in this country by 47 percent in 1997. HAART is a treatment regimen that uses a combination of reverse transcriptase inhibitors and protease inhibitors to treat patients. Patients who are newly infected with HIV as well as AIDS patients can take the combination.

While HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Researchers have shown that HAART cannot eradicate HIV entirely from the body. HIV remains present, lurking in hiding places such as the lymph nodes, the brain, testes, and the retina of the eye, even in patients who have been treated.

A number of drugs are available to help treat opportunistic infections to which people with HIV are especially prone. These drugs include

foscarnet and ganciclovir to treat cytomegalovirus eye infections
fluconazole to treat yeast and other fungal infections
trimethoprim/sulfamethoxazole (TMP/SMX) or pentamidine to treat Pneumocystis carinii pneumonia (PCP)

In addition to antiretroviral therapy, health care providers treat adults with HIV, whose CD4+ T-cell counts drop below 200, to prevent the occurrence of PCP, which is one of the most common and deadly opportunistic infections associated with HIV. They give children PCP preventive therapy when their CD4+ T-cell counts drop to levels considered below normal for their age group. Regardless of their CD4+ T-cell counts, HIV-infected children and adults who have survived an episode of PCP take drugs for the rest of their lives to prevent a recurrence of the pneumonia.

HIV-infected individuals who develop Kaposi's sarcoma or other cancers are treated with radiation, chemotherapy, or injections of alpha interferon, a genetically engineered naturally occurring protein. ³

Adolescents tend to think they are invincible, and therefore, to deny any risk. This belief may cause them to engage in risky behavior, to delay HIV testing, and if they test positive, to delay or refuse treatment. Doctors report that many young people, when they learn they are HIV-positive, take several months to accept their diagnosis and return for treatment. Health care professionals may be able to help these adolescents by explaining the information slowly and carefully, eliciting questions from them, and emphasizing the success of newly available treatments.

The U.S. Department of Health and Human Services (DHHS) has developed two documents that address the standard of care for the treatment of HIV, including information about how to treat HIV in adolescents. The documents, Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents and Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection are available from the National Prevention Information Network and the HIV/AIDS Treatment Information Service (telephone numbers are listed in the resources section). These documents also can be downloaded from the Internet at http://www.hivatis.org/.

According to the Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, adolescents who were exposed to HIV sexually or via injection drug use appear to follow a clinical course that is more similar to HIV disease in adults than in children. At this time, most adolescents with sexually acquired HIV are in a relatively early stage of infection and are ideal candidates for early intervention. Adolescents who were infected at birth or via blood products as young children follow a unique clinical course that may differ from other adolescents and long-term surviving adults. Health care workers should refer to the treatment guidelines for detailed information about the treatment of HIV-infected adolescents.⁴

Sixteen drugs have been approved for treating HIV infection. They are called antiretroviral drugs because they attack HIV, which is a retrovirus. Once inside the cell, HIV uses specific enzymes to survive. Antiretroviral drugs work by interfering with the virus' ability to use these enzymes. They fall into two categories.

Reverse transcriptase inhibitors interfere with an enzyme called reverse transcriptase or RT that HIV needs to make copies of itself. There are two main types of RT inhibitors and they each work differently.
- Nucleoside/nucleotide drugs provide faulty DNA building blocks, halting the DNA chain that the virus uses to make copies of itself.
- Non-nucleoside RT inhibitors bind RT so the virus cannot carry out its copying function.
Protease inhibitors interfere with the protease enzyme that HIV uses to produce infectious viral particles.

Drugs Approved for HIV Infection
Nucleoside/Nucleotide RT Inhibitors abacavir ddC ddI d4T 3TC ZDV tenofovir	Non-nucleoside RT Inhibitors delavirdine nevirapine efavirenz	Protease Inhibitors ritonavir saquinavir indinavir amprenavir nelfinavir lopinavir

Do antiretroviral drugs cure HIV infection?

No, the currently available drugs cannot cure HIV infection. This is because HIV can become resistant to any one drug. Researchers initially attacked this problem by using a combination of antiretroviral drugs to suppress the virus. By combining both RT inhibitors and protease inhibitors, NIAID-supported research groups and drug companies developed the potent and effective combination therapy called highly active antiretroviral therapy or HAART.

Although the use of HAART has greatly reduced the number of deaths due to AIDS, this powerful combination of drugs cannot suppress the virus indefinitely. In addition, while people with HIV are living longer, new medical problems are surfacing. These new problems have not been seen before in people who have been infected with the virus for a long time.⁵

Currently, there is no known cure for HIV/AIDS. The best treatment right now seems to be prescription "cocktails," or combinations of prescription drugs. These medications include those for antiviral treatment and other drugs, like oral antifungals to combat yeast infections, which fight diseases that take advantage of the weakened immune response of HIV-infected people. It is also important for HIV-infected women and their physicians to watch for pelvic inflammatory disease or other STDs through screening. Similarly, cervical cancer may be more common and progress more quickly in infected women; for this reason, women with HIV should have Pap Smears twice a year to make sure cancer is detected and treated early.⁶

Footnotes:
1. excerpt from NINDS Neurological Manifestations of AIDS Information Page: NINDS
2. excerpt from Backgrounder - HIV Infection in Infants and Children: NIAID
3. excerpt from HIV Infection and AIDS, An Overview, NIAID Fact Sheet: NIAID
4. excerpt from HIV Infection in Adolescents, NIAID Fact Sheet: NIAID
5. excerpt from Treatment of HIV Infection: NIAID
6. excerpt from Women and HIV-AIDS: NWHIC

Last revision: April 2, 2003

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