Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. To whom it may concern;
I'm working on a project that will hopefully prevent mis- and overdosage in
the future ... for a lot of risk groups.
One of the risk groups are AIDS patients. Would you be so kind and tell me where I can find information about how many drugs an AIDS Patient has to take, I know it always is depending on the stage the patient is in.
I need some numbers I can base my work on. What would be the number in the worst case?
Thanks a million for your help!
Rodger MacArthur, M.D.
Wayne State University
Division of Infectious Diseases
The number of drugs (medications) taken by an HIV-infected person depends on two main factors: 1) stage of infection, and 2) how many antiretroviral medications are required to maximally suppress the virus.
Many HIV-infected persons, especially early in the course of HIV infection, take no medications at all. In fact, new Department of Health and Human Services (DHHS) guidelines suggest that it may be reasonable to delay initiation of antiretroviral therapy until the CD4+ cell count has decreased to 200-350 cells/µL, values which are about 20-30% of those of an uninfected person. Conversely, individuals who delay initiating therapy until the CD4+ cell count is below 200 cells/µL run the risk of acquiring an opportunistic infection which increase greatly the number of medications needed.
The number of antiretroviral medications required to maximally suppress the virus depends on a number of factors, including the intrinsic potency of the antiretroviral combination, how well those medications are taken (adherence), and whether the combination is a person's first or subsequent regimen. In general, the more combinations of antiretroviral medications a person has taken, the greater are the number of medications required to maximally suppress the virus. Less than 100% adherence with the antiretroviral regimens allows the selection of drug-limiting mutations, which require increasing numbers of drugs to overcome.
In terms of actual numbers of medications, the average HIV infected person probably takes 3 different antiretrovirals early in infection, and 5 different antiretrovirals later in infection. The number of pills taken per day can range from 2 (with fixed-dose combination medications) to 20, with the average probably in the 6-10 range for antiretroviral medications alone. Additional medications are required for each opportunistic infection. Pneumocystis carinii pneumonia (PCP) often requires an additional 1 drug (1 pill per day) to prevent, and up to 8 pills per day (1 drug) to treat. Tuberculosis requires 2 or 3 drugs to treat (2-4 pills per day). Esophageal candidiasis requires 2 pills (1 drug) per day to treat. Cryptococcal meningitis requires 1-2 pills per day (1 drug) to treat.
In general, adherence with medications improves with decreasing numbers of pills taken. Adherence with medications, in turn, decreases the risk of acquiring opportunistic infections or drug-limiting mutations, and the need for additional medications in the future. But whether an individual takes 2 pills/day or 20 pills/day, therapy is often life-long, as it is with other chronic conditions, such as diabetes and hypertension.
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