It’s an all-in-one cocktail treatment for HIV.
Since the 1980s, the top treatment for HIV has been antiretroviral therapy (ART). These drugs target the virus to keep it from replicating and lower the viral load in your blood. The first ART medications lowered the number of people dying from HIV/AIDS, but there was still room for improvement. The biggest improvement came in the 1990s: combination antiretroviral therapy.
What is Combination Antiretroviral Therapy for HIV?
There are several different types of HIV medicines, and they each work in slightly different ways. Types of antiretroviral medications include:
- Nucleoside reverse transcriptase inhibitors (NRTIs) block an enzyme called reverse transcriptase, which creates complementary DNA from an RNA template.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) bind to and later change reverse transcriptase to prevent the conversion from RNA to DNA.
- Protease inhibitors (PIs) block an enzyme called protease, which cuts the virus into smaller fragments, easing the replication process.
- Integrase inhibitors block an enzyme called integrase, the enzyme that inserts the HIV genome into the DNA of the host cell.
Combination antiretroviral therapy simply refers to merging two or more classes of ART medication to improve treatment outcomes, often provided in a single once-a-day pill. Basically, this allows the medicine to attack HIV from different angles, so to speak.
“HIV unfortunately is a pretty smart virus. If you only introduced it to one drug, it would eventually learn the properties of that drug and mutate against it,” says Stella Safo, MD, an HIV internist at the Icahn School of Medicine at Mount Sinai. “The way we get around that is giving patients multiple classes of HIV medicines in one dose to make sure the virus can't outsmart the drug combinations we’re using.”
Combination antiretroviral therapy has led to a number of improvements in HIV treatment. Most notably, research shows that combination ART has led to a significant decrease in deaths from HIV or AIDS. It also has lowered the risk of developing a resistance to any individual ART medication.
Who is (Or Isn’t) Eligible for Combination ART?
Certain patients may have trouble taking combination regimens if they have difficulty swallowing from other conditions, such as candidal esophagitis, or more permanent disabilities from a stroke. However, alternative antiretroviral agents, like dolutegravir plus rilpivirine (small tablet regiments) may be available in those cases.
According to Dr. Safo, the world of HIV treatments has expanded tremendously. Now there are enough options that it’s relatively easy to find one that works for your lifestyle. That’s crucial since the treatment you can stick to is the treatment that can better help you lead a longer, healthier life.
Stella A. Safo, MD, is an HIV primary care physician and assistant professor of Medicine at the Icahn School of Medicine at Mount Sinai Hospital.
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