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04 Apr 2003

Effect of anti-retroviral
How does the antiretroviral help if you are HIV+?
Answer 335 views
HIV Peer Forum

01 Jan 0001

The antiretroviral drugs that are currently registered in the country are the drugs which work on the HIV viral enzymes which assist in the production of viruses. These drugs inhibit these enzymes thus decreasing the amount of viruses in the blood. It is therefore very important that the drugs taken are in sufficient quantity to suppress these enzymes as much as possible. If the enzymes are not suppressed completely, you can possibly get viruses being produced that are resistant to these drugs and then these drugs will become less effective in these patients.

With the decrease in the amount of virus in the blood, the infection of newly produced CD4 cells is decreased leading to an improvement in immune system and therefore a strengthening of that patient with the consequence of improved health and longer survival.

These drugs fall into three classes: the nucleoside reverse transcriptase inhibitors (NRTI), the non-nucleoside reverse transcriptase inhibitors (NNRTI) and the protease inhibitors. Ideally, there should be two drugs from the NRTI group and one from the NNRTI group or one or combination from the protease inhibitor group. Current treatment guidelines recommend one of the drugs from the NNRTI group to be part of the first-line treatment regimen. It is important that for the NRTI group that the thymidine analogue drugs not be used as a pair, i.e. AZT and d4T. They should be used in different regimens. It is also not recommended to use the ā€˜Dā€™, i.e. ddi and d4T drugs together because of the side-effect profile which is cumulative with these two, especially in pregnancy.

When to start therapy is also critical and it is recommended that patients start therapy only when they start displaying symptoms of HIV disease especially if the CD4 count is above 200. Certainly patients with CD4 counts below 200 should be on antiretroviral therapy. In patients who have no symptoms but with CD4 count above 200 -350, the decision to start therapy needs discussion between the patient and doctor. Latest research indicates that people should not wait until the CD4 count drops to below 200 but to start earlier. Certainly at this stage, patients would need to be clear of the commitment that would need to be made as they would have to stay on medication for life and that drug holidays can result in treatment failure as the virus develops resistance to these drugs.

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