Shortly following the discovery of HIV in 1981, a variety of monotherapy treatments, including the better-known treatment called AZT, were introduced to patients in an effort to slow the virus’s progression. Despite initial successes, these monotherapies proved ineffective due to the virus’s ability to develop quick resistances to single drug therapies.
In 1995, the combination treatment known as the “AIDS Cocktail” was introduced to patients infected with HIV/AIDS. This type of therapy has often been referred to as highly active antiretroviral therapy (HAART). However, it may also be called combination antiretroviral therapy (cART), or simply antiretroviral therapy (ART). No matter its name, dramatic improvements have been seen among patients receiving combination treatments since they were initiated.
Patients receiving combination therapy have reported decreased viral loads, increased CD4 counts, and increased T-cell counts. The life expectancies of HIV patients have become much closer to general mortality rates since the introduction of antiretroviral therapy. Therefore, the introduction and ongoing successes of the “AIDS Cocktail” has brought a sense of renewed hope about not only the longevity of an HIV-infected person’s life, but about his or her overall quality of life.
Combination Antiretroviral Therapy Drug Regimen Classes
A variety of antiretroviral drug therapies are currently available via prescription to HIV-infected patients. Each drug included in the combination therapy serves a unique purpose. The combination of drugs works to prevent the virus from replicating, and in many cases can restore the patient’s CD4 and T-cell counts, thus improving the quality and longevity of life.
The current classes of drugs included in antiretroviral therapies include:
- Nucleoside Reverse Transcriptase Inhibitors (NRTIs): The HIV virus requires reverse transcriptase (RT) in order to replicate. By offering faulty versions of the building blocks for replication to the viruses, the drug therapy works to block the virus’s ability to replicate.
- Non-Nucleoside Reverse Transcription Inhibitors (NNRTIs): These inhibitors effectively disable a key protein that HIV requires to replicate.
- Protease Inhibitors (PIs): This inhibitor disables the protein known as protease, another key building block required by HIV to replicate.
- Entry/Fusion Inhibitors: Unlike the previously mentioned drug therapies, this inhibitor blocks the virus’s ability to enter the body’s CD4 cells.
- Integrase Inhibitors: Once HIV has penetrated a CD4 cell, it inserts genetic material into the cells with the assistance of a protein known as integrase. This inhibitor blocks the virus’s ability to complete this crucial replication step.
Current Recommended HIV Treatment Protocols
According to the U.S. National Library of Medicine National Institute of Health, the current recommended drug combination for all HIV patients includes two NRTIs, a NNRTI, a PI, and either a ritonavir or integrase inhibitor.
The drug regimen recommended for each patient should take into consideration potential drug interactions, previous drug-resistance testing, and dosing frequency. Once a regimen is put into place, the patient’s ongoing reaction and success levels will be carefully monitored by his or her physician. In the event of severe side effects or proven ineffectiveness, alterations to the drug regimen will be recommended.
While antiretroviral treatments are currently recommended for all patients diagnosed with HIV, those who are currently pregnant, have previously reported an AIDS-defining illness, have been diagnosed with hepatitis B, and have had a recent CD4 count below 500 are considered priority. Once an antiretroviral treatment is initiated by a patient, it should be maintained indefinitely.
Previously, antiretroviral drug therapies relied upon achieving two primary outcomes: the inhibition of the proteins protease and reverse transcriptase. Today, recent approvals for additional HIV treatment options that block the virus’s entry into the body’s CD4 cells and the introduction of the virus’s genetic materials (entry inhibitors and integrase inhibitors) expand the number of combinations available to patients.