HIV AIDS medical therapy

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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.

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.

Anti Retroviral Therapy (ART)

▸ Click on the following categories to expand treatment regimens.

MDR Tuberculosis   ▸  Adults   ▸  Children

MDR-TB Adults Standard Regimen Group 1: First-line oral drugs ▸ Pyrazinamide 20–30 mg/kg OR ▸ Ethambutol 15–25 mg/kg OR ▸ Rifabutin 5 mg/kg PLUS Group 2: Injectable drugs ▸ Capreomycin 15 mg/kg OR ▸ Kanamycin 15 mg/kg OR ▸ Amikacin 7.5-10 mg/kg OR ▸ Streptomycin 12–18 mg/kg PLUS Group 3: Fluoroquinolones ▸ Levofloxacin 500-1000 mg OR ▸ Moxifloxacin 400 mg OR ▸ Ofloxacin 400 mg PLUS Group 4:Oral bacteriostatic second-line drugs ▸ Ethionamide 15-20 mg/kg OR ▸ Protionamide 15-20 mg/kg OR ▸ Cycloserine 10-15 mg/kg OR ▸ Terizidone 10-20 mg/kg OR ▸ Para-aminosalicylic acid 8-12 g/d divided q8-12h Table adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed. MDR-TB Children Standard Regimen Group 1: First-line oral drugs ▸ Pyrazinamide 20-30 mg/kg (Max: 600 mg) OR ▸ Ethambutol 15-20 mg/kg OR ▸ Rifabutin 5 mg/kg PLUS Group 2: Injectable drugs ▸ Capreomycin 15-30 mg/kg (Max: 1000 mg) OR ▸ Kanamycin 15-30 mg/kg (Max: 1000 mg) OR ▸ Amikacin 15-22.5 mg/kg (Max: 1000 mg) OR ▸ Streptomycin 12-18 mg/kg PLUS Group 3: Fluoroquinolones ▸ Levofloxacin 7.5-10 mg/kg OR ▸ Moxifloxacin 7.5-10 mg/kg OR ▸ Ofloxacin 15-20 mg/kg divided q12h (Max:800 mg) PLUS Group 4:Oral bacteriostatic second-line drugs ▸ Ethionamide 15-20 mg/kg divided q12h (Max: 1000 mg) OR ▸ Protionamide 15-20 mg/kg divided q12h (Max: 1000 mg) OR ▸ Cycloserine 10-20 mg/kg (Max: 1000 mg) OR ▸ Terizidone 10-20 mg/kg (Max: 1000 mg) OR ▸ Para-aminosalicylic acid 150 mg/kg divided q8-12h(Max: 12 000 mg) Table adapted from WHO 2013 Treatment of tuberculosis: guidelines – 4th ed. and Guidance for national tuberculosis programmes on the management of tuberculosis in children

Related Chapters

• HIV Treatment
• Antiretroviral drug
• Antiretroviral therapy in pregnancy
• Immune reconstitution inflammatory syndrome