ARV treatment should stop a person from becoming ill for many years. For many people the therapy works without any major problems. However, sometimes there can be difficulties related to drug resistance, drug interactions, side effects and adherence.
This page provides information about the issues that a person may face when continuing their antiretroviral treatment.
The following information continues from the pages introduction to HIV & AIDS treatment and starting HIV & AIDS treatment.
New HIV Treatment Guidelines Issued
New HIV treatment guidelines issued by the International AIDS Society–USA urge starting therapy sooner. The guidelines incorporate both newly approved drugs and a greater understanding of disease pathology.
They were unveiled here at a news conference in Mexico City prior to the start of the AIDS 2008: XVII International AIDS Conference and are published in the August 6 issue of the Journal of the American Medical Association.
The recommendations "are built on the precept of integrated pathogenesis of HIV infection along with the best evidence that we have got to individualized therapy," said Scott Hammer, MD, Columbia University College of Physicians and Surgeons in New York, NY, who made the presentation on behalf of the panel that developed the guidelines. The 15 members were drawn from 6 different countries.
While written for wealthier nations, Dr. Hammer said, "The principles that we espouse are universally applicable to middle income countries and hopefully, eventually are translatable to low resource settings." The goal is to achieve maximum suppression of the virus, with minimal toxicity, and maximum simplicity. "When you do this you promote adherence and minimize resistance."
The 3 drugs approved since the last version of the guidelines in 2006 are maraviroc, which Dr. Hammer called "a very important addition to the armamentarium" because it is the first drug to target the CCR5 co-receptor on the surface of the cell; raltegravir, the first drug in the integrase inhibitor class; and etravirine, a second-generation nonnucleoside reverse transcriptase inhibitor (NNRTI) "with clear activity against some NNRTI-resistant viruses."
The emergence during the past 2 years of "regimens that are potent, durable, more simple than they were before, and safer, [plus] better formulations with improved pharmacokinetics which enhance adherence and therefore diminish resistance — overall present us with more treatment options, not just to start but most importantly on the second, third, and fourth rounds of treatment."
The guidelines move aggressively toward earlier initiation of antiretroviral therapy, prior to a decline in CD4 cell count less than 350/µL, if certain other clinical conditions are present.
Referring to the SMART (The Strategies for Management of Antiretroviral Therapy) study, he said, "Uncontrolled HIV replication (>100,000 copies/mL) and resulting immune activation are associated with non-AIDS illnesses — cardiovascular, hepatic, and renal events, and non-AIDS malignancies, really a potpourri of issues that are not classically thought of as HIV disease related disease progression." Individuals with incomplete virologic suppression have greater morbidity and mortality than those who more completely suppress it.
Dr. Hammer said the definition of HIV disease progression has broadened because "HIV viremia and the immune activation that accompanies that intersects with the host and organ systems in a number of different ways."
New Therapy For HIV Treatment
Millions of people world-wide who have contracted a highly resistant strain of HIV could benefit from a new drug to treat the infection, according to UNSW research.
Co-authored by UNSW's National Centre in HIV Epidemiology and Clinical Research (NCHECR), the research shows that the majority of patients who have not responded to traditional treatments have had good results from a new combination therapy involving raltegravir.
Raltegravir is already available in Australia and was listed on the Pharmaceutical Benefits Scheme on July 1st, with clinical trials showing that it is safe, effective and with minimal side-effects when used with other anti-HIV medicines.
The study, which has been published in the New England Journal of Medicine, shows raltegravir lowers the amount of virus in the blood to undetectable levels in 62 percent of people taking it in combination with other anti-HIV medicines.
Only one in three people who received a placebo plus other anti-HIV medicines had the amount of virus in the blood reduced to similar levels.
“This is the first drug in a new class of antiretroviral drugs called integrase inhibitors,” says UNSW Professor David Cooper AO, the Director of NCHECR. “The drug has a different mechanism of action, is very potent, seems very safe and has helped patients who have a virus that is resistant to older drugs and classes.
“It initially will be used in developed countries, but hopefully it will be made available at cheaper prices for patients in developing countries who are facing the same problems,” Professor Cooper says.
The results were based on analyses of viral load reductions and CD4 cell count increases. A high CD4 cell count is crucial for a healthy immune system.
The overall results have been drawn from two major ongoing clinical trials in Europe, Asia, Australia and North and South America. Both studies are supported by Merck & Co, Inc., the manufacturer of raltegravir.
Professor Cooper is the first author of the second of two papers published in this edition of the New England Journal of Medicine. The first is led by Professor Roy Steigbigel from Stony Brook University Medical Center.