HIV Treatment Alerts - June 2004
Marjorie Williams, MPH

While it is true that less expensive and less toxic HIV medications are needed, it can hardly be denied that what is available today is far better than what was available just a few years ago—and slowly, more treatment options are coming.

Currently, there are 4 groups of antiretroviral medications used to treat HIV/AIDS: 1) nucleoside/nucleotide reverse transcriptase inhibitors or "nukes," 2) non-nucleoside reverse transcriptase inhibitors or "non-nukes," 3) protease inhibitors, and 4) entry inhibitors (see table below). These different groups of drugs interact with HIV in different ways to interrupt the HIV lifecycle (see diagram below).

When an individual starts to take a combination of HIV medications, this type of therapy is known as HAART. HAART stands for Highly Active Antiretroviral Therapy. HAART usually combines 2 nukes with either a non-nuke or a protease inhibitor. In some situations (especially if HIV drug resistance is a problem), these types of medications may be combined together in different ways, sometimes also including an entry inhibitor. Scientists have found that combining the groups of HIV medications helps to decrease the chances that the virus will become resistant to any one group.

Patients recently diagnosed with HIV may assume that they will immediately begin HAART. However, current guidelines established by the US Department of Health and Human Services actually recommend that treatment should be considered by any individual who has a T cell count of less than or equal to 350 or who has a viral load of more than 55,000. HAART is definitely recommended for anyone with a T cell count of 250 or less or for anyone who has an opportunistic infection (For a complete copy of the latest guidelines, visit www.AIDSinfo.nih.gov).

There are 3 main reasons for these treatment guidelines. First, HIV medications are toxic and they can cause dangerous side effects, including allergic reactions and gastrointestinal difficulties. Second, HIV is able to change itself so that treatments become less effective. This makes it difficult for people to stay on any one drug combination for a long time. Finally, HIV drugs can be very expensive. As new medications are approved and new research tells us more about the best ways to treat HIV, the guidelines change accordingly. The treatment of HIV and what we knew back in the 1990s is very different from today.

Overall, HAART can be an effective way to manage HIV/AIDS. Individuals on therapy have lived longer and experienced a higher quality of life. However, it is important to remember that although most people with HIV will have to be treated with HAART eventually, being diagnosed with HIV does not mean one should start HAART immediately. Individuals with HIV should work closely with their healthcare providers to determine if they have a need for therapy and to discuss the benefits and liabilities of being on HAART.

TABLE: Currently approved medications for treating HIV/AIDS

Diagram: the HIV lifecycle

Entry Inhibitors: This type of medication blocks HIV from fusing with the T cell membrane and subsequently reproducing in the cell (see #1 in diagram).

Nucleoside/Nucleotide reverse transcriptase inhibitors (nukes): These medications interfere with viral reverse transcriptase by acting as "fake building blocks" that disrupt the creation of proviral DNA needed to take over the infected cell to build new viruses (see #2 in diagram).

Non-nucleoside reverse transcriptase inhibitors (non-nukes): These medications also block the viral reverse transcriptase but do so by directly binding to that enzyme (see #2 in diagram).

Protease inhibitors: These medications block protease enzymes, which cut viral proteins into the appropriate sizes for placement into new HIV particles. Thus, the virus is unable to produce new infectious particles (see #4 in diagram).

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Copyright © 2004 - Research Initiative Treatment Action (RITA!). Reproduced with permission. RITA! is published by The Center for AIDS. Contact Thomas Gegeny, MS, ELS, Editor, RITA! for permission to reproduce RITA!. tom@centerforaids.org. http://www.centerforaids.org

AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, Bridgestone/Firestone Charitable Trust, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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