Advances in Antiretroviral Therapy

Advances in Antiretroviral Therapy

Antiretrovirals are drugs that are used to treat viral infections like HIV. Since their introduction in 1987, antiretrovirals have shown significant advancements. Experts like Best Sexologist in Islamabad now use the Highly Active Antiretroviral Therapy (HAART) to treat HIV-1 infection. In fact, healthcare professionals now manage it as a chronic disease.

What is the new HAART for HIV Patients?

The Highly Active Antiretroviral Therapy (HAART) options for both treatment-naïve and treatment-experienced patients of HIV include: nucleoside reverse transcriptase inhibitors (NRTIs), Entry inhibitors, Non-nucleoside reverse transcriptase inhibitors (NNRTIs), chemokine receptor antagonists (CCR5 antagonists), Protease inhibitors (PIs), Fusion inhibitors and Integrase Inhibitors (INSTs).

Single pill Regimens

In the early days of Anti-retroviral therapy, the high pill-burden made compliance of the patient, poor. This in turn endangered the effectiveness of treatment and also increased the chances of resistance development. Today, the US department of health and human services (DHHS) recommends the single tablet regimens for HIV patients, especially for the initial phase, to ensure compliance and adherence to treatment.

What is the Goal of Haart?

The goal of therapy in HAART is to reduce the morbidity and mortality associated with HIV, to improve the quality of life of patients and to reduce the transmission of HIV-1 to others. Additionally, healthcare providers aim to prevent drugs resistance, improve the immune function and reduce the viral RNA load with the right therapeutic approach.

A combination of HAART is also recommended for those who engage in high-risk behavior, as well as in pregnant mothers with HIV, to decrease the vertical transmission of infection.

HIV antiretroviral drugs: Types and side effects

What are the Contraindications for Haart?

All healthcare providers put the HIV positive patients on HAART, immediately, regardless of their CD4 count. There are no outright contraindications to HAART, but certain medications in the regimen can be contraindicated or some reason. In this situation doctors find an alternate HAART combination but do not stop the medication. Some specific contraindications include:

Avoidance of efavirenz in patients with hepatic dysfunction and psychiatric illness. Efavirenz and abacavir should also be avoided in patients with cardiovascular disease with history of torsade de pointes. Abacavir should also be avoided in patients with history of delayed hypersensitivity reaction.

Monitoring of Haart

HAART has improved patient outcomes and reduced the transmission of virus in HIV positive patients. Monitoring of medication, overseeing for side-effects and proper adherence to HAART is necessary for therapeutic response.

Prior to treatment initiation, healthcare professionals need to maintain history and screen for risk factors such as osteoporosis, renal dysfunction, cardiovascular disease, hepatitis B and C and tuberculosis. Healthcare providers need to be vigilant when the patients are considered high risk such as those with history of psychiatric illness, those with history of substance abuse and those living in resource-limited setting. Such patients are considered high risk for noncompliance.

HIV Guidelines for Pediatric Population

HIV positive women who are pregnant or trying to conceive should be put on dolutegravir. Tenofovir is an alternative antiretroviral that may be used. Direct acting antiviral treatment can be initiated in pregnant women who are co-infected with hepatitis C. For more tailored treatment, its best to seek help of professionals like Best Sexologist in Lahore