HIV AIDS medical therapy: Difference between revisions

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<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
<font color="#FFF">
'''Anti-Retroviral Regimens'''
'''Recommended Regimens'''
</font>
</font>
</div>
</div>
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<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Recommended Regimen'''
&nbsp;&nbsp;▸&nbsp;&nbsp;'''NNRTI-Based Regimen'''
</font>
</font>
</div>
</div>


<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Alternative Regimen'''
&nbsp;&nbsp;▸&nbsp;&nbsp;'''PI-Based Regimen'''
</font>
</font>
</div>
</div>


<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;''' Regimen'''
&nbsp;&nbsp;▸&nbsp;&nbsp;'''INSTI-Based Regimen'''
</font>
</font>
</div>
</div>
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Alternative Regimens'''
</font>
</div>
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''PI-Based Regimen'''
</font>
</div>
<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''INSTI-Based Regimen'''
</font>
</div>


| valign=top |
| valign=top |
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|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''Efavirenz/Tenofovir/Emtricitabine<sup>†</sup>'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''Efavirenz/Tenofovir/Emtricitabine<sup>†</sup>'''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''NNRTI-based regimen for patients with HIV RNA < 100,000 copies/mL'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''Efavirenz''' <br> PLUS <br> ▸ '''Abacavir/Lamivudine<sup>†</sup> <small>(only for HLA-B*5701 negative patients)</small>'''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''Rilpivirine/Tenofovir/Emtricitabine<sup>†</sup> <small>(only for patients with CD4 < 200 cells/mm³)</small>'''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Recommended Regimen}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''PI-Based Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''PI-Based Regimen'''''
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|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''Darunavir/Ritonavir(low dose)''' <br> PLUS <br> ▸ '''Tenofovir/Emtricitabine<sup>†</sup>'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''Darunavir/Ritonavir(low dose)''' <br> PLUS <br> ▸ '''Tenofovir/Emtricitabine<sup>†</sup>'''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''PI-based regimen for patients with HIV RNA < 100,000 copies/mL'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''Atazanavir/Ritonavir(low dose)''' <br> PLUS <br> ▸ '''Abacavir/Lamivudine<sup>†</sup> <small>(only for HLA-B*5701 negative patients)</small>'''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Recommended Regimen}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''INSTI-Based Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''INSTI-Based Regimen'''''
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|}
|}
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| valign=top |
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Alternative Regimen<br><small>(for patients with HIV RNA < 100,000 copies/mL)</small>}}
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Alternative Regimen}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''NNRTI-Based Regimens'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''PI-Based Regimens'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''Efavirenz''' <br> PLUS <br> ▸ '''Abacavir/Lamivudine<sup>†</sup> <small>(only for HLA-B*5701 negative patients)</small>'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''Rilpivirine/Tenofovir/Emtricitabine<sup>†</sup> <small>(only for patients with CD4 < 200 cells/mm³)</small>'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸  
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''PI-Based Regimens'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''Atazanavir/Ritonavir(low dose)''' <br> PLUS <br> ▸ '''Abacavir/Lamivudine<sup>†</sup> <small>(only for HLA-B*5701 negative patients)</small>'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸  
|-
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Alternative Regimen}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''PI-Based Regimens'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left | <small>Adapted from </small>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸
 
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''INSTI-Based Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small>Table adapted </small>
|}
|}
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| valign=top |
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|INSTI-Baded Regimen}}
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Alternative Regimen}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Standard Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''INSTI-Based Regimens'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small>Table adapted </small>
|}
|}
|}
|}

Revision as of 16:03, 1 October 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The primary goal of antiretroviral therapy (ART) is to reduce HIV-associated morbidity and mortality. This goal is best accomplished by using effective ART to maximally inhibit HIV replication, as defined by achieving and maintaining plasma HIV RNA (viral load) below levels detectable by commercially available assays. Durable viral suppression improves immune function and quality of life, lowers the risk of both AIDS-defining and non-AIDS-defining complications, and prolongs life. Based on emerging evidence, additional benefits of ART include a reduction in HIV-associated inflammation and possibly its associated complications.

Medical Therapy

Anti-HIV Medication

Anti-HIV medications (also called antiretrovirals) are grouped into six drug classes according to their mechanism of action. The six classes are as follows:

  1. Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
  2. Nucleoside reverse transcriptase inhibitors (NRTIs).
  3. Protease inhibitors (PIs).
  4. Fusion inhibitors.
  5. CCR5 antagonists.
  6. Integrase inhibitors.

Multidrug regimen has proved to be very beneficial because of reduction in progression to AIDS, opportunistic infections, rate of hospitalizations and deaths. [1]

Goals of Therapy

DHHS ART Guidelines present the following goals for therapy:

  • Durable suppression of HIV viral load ( to <50 cells/mL ).
  • Restoration of normal CD4 cell count.
  • Prevention of transmission of the disease.
  • Prevention of building of drug resistance.
  • Improvement in quality of life of the patient.

Uncontrolled viremia causes inflammation and immune activation, which has an overall effect on cardiovascular, renal and hepatic systems. Controlling viremia also controls these effects.

Indications

Anti Retroviral Therapy (ART)

▸ Click on the following categories to expand treatment regimens.

Recommended Regimens

  ▸  NNRTI-Based Regimen

  ▸  PI-Based Regimen

  ▸  INSTI-Based Regimen

Alternative Regimens

  ▸  PI-Based Regimen

  ▸  INSTI-Based Regimen


Recommended Regimen
NNRTI-Based Regimen
▸ Efavirenz/Tenofovir/Emtricitabine†
NNRTI-based regimen for patients with HIV RNA < 100,000 copies/mL
▸ Efavirenz
PLUS
▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients)
OR
▸ Rilpivirine/Tenofovir/Emtricitabine† (only for patients with CD4 < 200 cells/mm³)
Recommended Regimen
PI-Based Regimen
▸ Atazanavir/Ritonavir(low dose)
PLUS
▸ Tenofovir/Emtricitabine†
OR
▸ Darunavir/Ritonavir(low dose)
PLUS
▸ Tenofovir/Emtricitabine†
PI-based regimen for patients with HIV RNA < 100,000 copies/mL OR
▸ Atazanavir/Ritonavir(low dose)
PLUS
▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients)
Recommended Regimen
INSTI-Based Regimen
▸ Dolutegravir
PLUS
▸ Abacavir/Lamivudine† (only for HLA-B*5701 negative patients)
OR
▸ Dolutegravir
PLUS
▸ Tenofovir/Emtricitabine†
OR
▸ Elvitegravir/Cobicistat/Tenofovir/Emtricitabine†(contraindicated in patients with CrCl <70mL/min)
OR
▸ Raltegravir
PLUS
▸ Tenofovir/Emtricitabine†
†Emtricitabine may be substituted for lamivudine or vice versa
‡
Adapted from
Alternative Regimen
PI-Based Regimens
▸
OR
▸
OR
▸
Adapted from
Alternative Regimen
INSTI-Based Regimens
▸


Related Chapters

References

  1. ↑ Sterne JA, Hernán MA, Ledergerber B, Tilling K, Weber R, Sendi P, Rickenbach M, Robins JM, Egger M (2005). "Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study". Lancet. 366 (9483): 378–84. doi:10.1016/S0140-6736(05)67022-5. PMID 16054937. Retrieved 2012-02-15.
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