Medications for hiv treatment

Treatment:

• Preventive          
• Definitive
  

Preventive measures include:

•  Safer sex’ practice by health education. Use of latext condoms and spermicides will prevent HIV.
• Use of blunt tipped needles to avoid needle stick injury during surgery. 
•  HIV negative blood transfusion (screening of 'donors).
•  HIV negative frozen semen to use for artificial donor insemination.
• 'To maintain protocols for correct handling of all body fluids 
• 'Postexposure prophylaxis with zidovudine and lamivudine is advisable.
• 'Termination of pregnancy in HIV positive women.
• Avoiding breastfeeding -in the developing world, avoidance of breastfeeding may not be possible. Mother needs to be counselled
• as regard the risks and benefits of breastfeeding. She is helped to make an informed choice. . ' .'
• 'Wide spread voluntary counselling and testing
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Definitive

HIV treatment protocols change frequently.

Antiretroviral therapy

: Antiretroviral drugs are grouped into -

 (A) Nucleoside Reverse Transcriptase Inhibitors (NRTIS) : Zidovudine, Zalcitabine, Lamivudine, Stavudine.

 (B) Non-Nucleoeide ReverseTranscriptase Inhibitors (NNRTIS) : Delvirdine, levirapine, Efavirenz.

 (C) Protease Inhibitors (PI) : Indinavir, Saquinavir, Ritonavir, Amprenavir

. D) Fusion inhibitor : Enfuvirtide. The combinations of these drugs are effective in increasing CD4 counts and reducing viral load. Monotherapy is not used as it hastens drug resistance. Combination therapy is known by the acronym HAART (Highly Active Antiretroviral Therapy).

Drug combinations :

• Up to date treatment recommendations available at: www.A.IDSinfo.nih.gov.
•  Two from Gr. A (NRTIs) plus one from Gr. 8 OR 2 from Gr. A (NRTls) plus one from Gr. C (PI).
• Plasma HIV RNA levels indicate the degree of viral replication and CD4 + T cell count indicate level of immune competence.
• Important side effects of drugs - lactic acidosis, anemia, granulocytopenia, pancreatitis, peripheral neuropathy, hepatic dysfuncction and carbohydrate intolerance

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When to start therapy: 

• Acute HIV infection syndrome. 
• Symptomatic HIV infection.
• Asymptomatic but CD 4 cell count < 350cells/id or with viral load HIV RNA 50,000 copies/ml.
•  Post-exposure prophylaxis 
• With effective treatment viral load should reach 'undetectable’ levels (< 50 copies/ml) and CD4 count should rise.
•  Patients with CD 4 count < 200/ Ml should also receive trimethoprim and aulphamethoxazole combination ( carinii prophylaxis).
•  Opportunistic infections (mycobacterium) should be treated simultaneously with specific drugs when CD4 + T cells < 50/ul.
•  Colposcopy and cervical cytology screening should be routinely done.
• Zidovudine is given in a dose of 200 mg every 8 hours. Nevirapine is found to reduce the viral transmission to breastfed infants.

When to change

 (i) Failure to reduce viral load.

 ii) Persistently declining CD43 + T cell count.

 (iii) Clinical deterioration.

Postexposure Prophylaxis 

          A combination of2 NRITs is given for 4 weeks. Prophylactic use zidoudine (300 mg bid) and lamivudine (150 mg bid) for a period of 4 weeks immediately followig an exposure may reduce the  risk of seroconversion (CDC-2001).

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