Antiretroviral Drugs

Antiretroviral drugs (drugs that fight against HIV) are the most effective intervention to date in managing HIV infection. These drugs have the potential to dramatically improve the health and extend the lives of many people living with HIV/AIDS.

Antiretroviral drugs work by interfering with HIV’s life cycle and its ability to reproduce. This group of drugs includes reverse transcriptase inhibitors, which work by neutralizing an enzyme HIV needs at the beginning of its life cycle, and protease inhibitors, which neutralize an enzyme HIV needs near the end of its life cycle.

List of available
antiretroviral agents

The goals of antiretroviral drugs are to prolong the health and life of HIV-infected clients, improve the symptoms of HIV infection, improve immune function, and suppress the replication and mutation of HIV.

In developed countries, combination therapy, in which several antiretroviral drugs (usually three or more) are used together, has been credited with the decline in the number of HIV infections that progress to AIDS and the number of AIDS-related deaths. Studies have shown a dramatic reduction in the viral load (level of virus in the blood) through combining various antiretroviral drugs.

Protease inhibitors may eventually prove to be more effective than reverse transcriptase inhibitors, or the two together may prove to fight HIV in ways that either alone does not (in fact, many treatment experts are saying as much already). As this course is being written, however, all we really know for certain is that protease inhibitors seem less toxic than reverse transcriptase inhibitors and reduce the level of HIV in the blood to a greater degree than reverse transcriptase inhibitors.

Treatment regimens and adherence

Both the client and the provider should agree on an approach to drug therapy, and health providers should discuss the risks and benefits of any available treatment options.

Treatment regimens may be difficult for clients to follow. Antiretroviral drugs can cause a number of side effects that clients need to learn to deal with or can require clients to switch to other drugs if the side effects are too severe. In addition, combination therapy requires taking a large number of pills on a complicated schedule.

Common side effects
of antiretroviral drugs

Different clients may have widely different views about taking these drugs. For example, some clients may be skeptical about taking drugs with potentially significant side effects, while others may request the most aggressive therapies possible. In addition, it is difficult to predict whether clients will be willing or able to adhere to a complicated schedule of medication.

Adherence to a drug regimen—taking every dose of the prescribed drug(s) when and how it is prescribed—is critical to the success of treatment; missing even a single dose can compromise suppression efforts or contribute to the development of resistant strains of HIV. Effective treatment requires health care providers to design therapy with individual adherence in mind.

Because of the long-term consequences of the development of drug-resistant HIV strains, the initial therapy tried should be considered “the best shot” at the virus. To maximize the possibility of success, clients should undertake a treatment regimen only after they are fully committed to it and ready for treatment and are assured adequate supplies of medication.

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