The Incredible Advancement in the Treatment of HIV

About 30 years ago, getting tested as HIV positive spelt doom; however, things have changed now and good news is now HIV is a condition which can be managed efficiently with the right treatment and medicines.^{(1, 5)}

Let us be clear and first mention that as of now there is no cure for AIDS or HIV. However, there have been some remarkable steps forward in the clinical understanding and treatment of the progression of HIV, which allows patients suffering from it to live better and longer lives.⁽¹⁾

Let us now delve deeper into the HIV treatment present today and the effects of it on the patients and the future of the HIV treatment.

In today’s times, antiretroviral medications are the primary treatment for HIV.⁽¹⁾ Antiretroviral medications work by suppressing the virus and decreasing its progression in the body. These medications cannot remove the virus or the disease from the body, but can suppress the virus such that it cannot be detected in many cases. If an antiretroviral medicine is beneficial and works for a patient, then it can contribute greatly in productive and healthy years to the patient’s life along with decreasing the risk of transmission to other people.

There are five categories of antiretroviral treatments prescribed for HIV positive patients and these are:

• Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs).
• Integrase strand transfer inhibitors (INSTIs).
• Protease inhibitors (PIs).
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
• Entry inhibitors.

The following medications have been approved by FDA for treatment of HIV.

NRTIs are the medications that prevent cells which have HIV in them from duplicating themselves by hindering the reconstruction of the DNA chain of the virus when it utilizes the enzyme reverse transcriptase. Some of the medications in this class are: lamivudine; abacavir; zidovudine; emtricitabine; tenofovir alafenamide fumarate and tenofovir disoproxil fumarate.

Tenofovir alafenamide fumarate is utilized in various combination pills for treating HIV. This drug when used by itself has gotten tentative approval for the treatment of HIV and has been approved by the FDA for treatment of chronic hepatitis B infection. Some of the other drugs in this category that can be used for treating hepatitis B are: tenofovir disoproxil fumarate, lamivudine and emtricitabine.

Zidovudine is also known as AZT or azidothymidine was the first FDA approved drug for the treatment of HIV. Nowadays, this medicine is more commonly used as post-exposure prophylaxis in newborns with mothers who are HIV-positive.

Some Of The Combination NRTIs Are:⁽¹¹⁾

• TRIZIVIR (zidovudine, lamivudine and abacavir).
• TEMIXYS and CIMDUO (lamivudine, tenofovir disoproxil fumarate)
• TRUVADA (tenofovir disoproxil fumarate and emtricitabine).
• DESCOVY (tenofovir alafenamide fumarate, emtricitabine).
• EPZICOM (lamivudine and abacavir).
• COMBIVIR (zidovudine and lamivudine).
• Truvada and Descovy other than for treating HIV can also be utilized as a part of a PrEP or pre-exposure prophylaxis regimen.

This class of drugs work by disabling integrase, which is an enzyme used by HIV to place DNA of the HIV into the DNA of the humans within the CD4 T cells. INSTIs are a part of the class of drugs termed as integrase inhibitors, which are well-established drugs. Other categories of integrase inhibitors like integrase binding inhibitors (INBIs) are known as experimental drugs, which are yet to receive approval from the FDA.

Medications belonging to the INSTIs are: dolutegravir; raltegravir; elvitegravir; and bictegravir.

Protease Inhibitors (PIs): Protease Inhibitors work by disabling the enzyme protease, which is needed by HIV as a part of its life cycle. Some of the medications belonging to this category are: darunavir; atazanavir; indinavir; fosamprenavir; lopinavir; Ritonavir; nelfinavir; ritonavir; tipranavir; Norvir and saquinavir. The medications saquinavir, nelfinavir and indinavir are rarely used due to their side effects.

This class of medications works in treatment of HIV by preventing the HIV from duplicating itself and inhibiting the enzyme reverse transcriptase. Some of the drugs belonging to the category of NNRTIs are: nevirapine; efavirenz; doravirine; etravirine and rilpivirine.

Entry Inhibitors: Entry inhibitors work in treating HIV by blocking HIV from entering the CD4 T cells. Medications belonging to this category are: ibalizumab-uiyk; maraviroc and enfuvirtide. This class of drug is rarely used as first-line HIV treatment.

Antiretroviral Therapy: The HIV can alter and develop resistance to a single medication. This is the reason why many healthcare professionals choose to prescribe multiple HIV medications together. Antiretroviral therapy is where combination of two or more antiretroviral drugs are used for treating HIV. This is the usual line of treatment prescribed for patients diagnosed with HIV.

Antiretroviral therapy was first introduced in 1995 and thanks to this effective therapy, deaths related to AIDS in America were decreased by 47% between the years 1996 and 1997.⁽¹²⁾ The commonly prescribed medication regimen contains two NRTIs and either an NNRTI or INSTI or a PI boosted with cobicistat. New data has emerged that supports the use of only two drugs like INSTI and an NNRTI or NSTI and an NRTI.

The advancements in the HIV medications are also making it easier for a patient to adhere to their treatment regime. Thanks to these advances, a person diagnosed with HIV need to not take increased amount of medications needed as previously. These new HIV treatments also have less number of side effects for many patients using antiretroviral medications. Last but not the least, these advancements in HIV treatments also consist better drug to drug interaction profiles.

The meaning of adherence is sticking and continuing with the prescribed treatment plan for HIV. Adherence is vital for treatment of HIV. If a patient with HIV is not taking their medications as prescribed, then the drugs will not work as effectively or stop working altogether resulting in progression of the virus. Adherence means being diligent and taking every single dose, daily as advised by the doctor.

One major and important advancement that is making lives easier and treatment regime easier for HIV patients following antiretroviral therapy is the advancement of combination pills. These combination medications are the commonly prescribed treatment for patients suffering from HIV and who haven’t sought treatment before.

Combination pills are those which have more than one drug in a single pill. As of now, there are eleven combination pills for HIV treatment that have two antiretroviral drugs. Currently about 12 combination pills are there which have three or more antiretroviral drugs in them.

The most recommended drug regime for treatment of HIV is the INSTI-based combination tablets, as they are not only effective, but cause fewer side effects when compared to other treatment regimes. Some of the examples consist of Genvoya, Triumeq and Biktarvy.

Atripla is an HIV drug that was approved by FDA in 2006 and was among the first effective combination pill containing three antiretroviral drugs. However, this medicine is used very less now because of its side effects that include mood changes and sleep disturbances.

A single-tablet regimen (STR) is also a treatment plan which consists of a single tablet with a combination of about three antiretroviral drugs in it. However, there are a few newer combinations which contain two-drugs from different classes and are approved by FDA as complete treatment regimen for HIV and they also are termed as STRs.

Even though combination pills are the latest development in the HIV treatment and they show good results too, not every patient may be suitable for this kind of drug therapy. It is important for the patient and the doctor to have discussion regarding this and decide on the suitable treatment plan according to each patient.

New therapies are developing and finding more ground each year with regards to treating and finding a possible cure for HIV. Research is going on regarding antiretroviral nanosuspensions for prevention and treatment of HIV. These medications need to be taken every four to eight weeks and this could improve the adherence rate by cutting down on the amount of medications a patient needs to take.

A combination of rilpivirine with cabotegravir given in a monthly injection form is thought to be available soon for HIV-1 infection treatment.

A weekly injection known as Leronlimab shows promising results in patients who are resistant to or not responding to HIV treatment in clinical trials.⁽¹⁶⁾ This injection has gotten the status of “Fast Track,” which will fasten the development process of this particular drug.^{(4, 16)}

Research is going on for development of HIV vaccine and is showing good results.⁽¹⁷⁾

To know more about the latest HIV treatment and the medicines available now or in the future, keep in touch with your pharmacist or healthcare professional.

References:

Also Read:

• Human Immunodeficiency Virus (HIV) Infection/AIDS: Symptoms, Topical Treatment, NSAIDs
• Retrovirus or HIV Infection: Transmission, Treatment, Clinical Manifestation, Prevention, Opportunistic Infections
• Symptoms and Stages of HIV
• Opportunistic Infections and Their Relationship with HIV/AIDS
• HIV Life Expectancy: How Long Can Someone Live With HIV?
• What Is HIV Pain & How To Manage Pain in HIV?
• Fact Check: HIV Transmission Myths
• What are the Early Signs and Symptoms of HIV?