Starting Antiretroviral Therapy
Because the human immunodeficiency virus will likely evolve resistance if combination therapy is started but not adhered to, it is essential for patients who choose antiretroviral therapy to understand the consequences of missing doses. Patients must make a life-long commitment to the therapy. Carelessness increases the development of HIV resistance and may increase the risk for spreading infection with resistant HIV.
Should antiretroviral treatment be started during the primary HIV infection? Primary infection, or acute HIV syndrome, is the period between initial infection and the development of antibodies to HIV. It occurs approximately 3 to 6 weeks after infection. The clinical benefits of potent antiretroviral therapy at this early stage of HIV infection are unknown. Some physicians and researchers believe that early intervention is best, but potential long-term toxicity and other side effects must be carefully considered. Patients should discuss potential advantages and disadvantages of starting antiretroviral therapy early in the course of infection with a qualified health care provider.
ARVT types
As of January 2008, there were 32 FDA-approved antiretrovirals in use in the United States. Types of antiretrovirals include the following:
- Nucleoside reverse transcriptase inhibitors (NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Protease inhibitors (PIs)
- Fusion inhibitor (e.g., enfuvirtide [Fuzeon®])
- Entry inhibitor (e.g., maraviroc [Selzentry®])
- Multi-class combination drug (e.g., Atripla®)
- HIV integrase strand transfer inhibitor (e.g., raltegravir [Isentress®])
More information about antiretrovirals and other HIV/AIDS drugs can be found at the U.S. Department of Health and Human Service AIDSinfo Drug Database, which contains information about pharmacology (how a drug works in the body), usage, side effects, and contraindications (a symptom or circumstance indicating that the patient should not take a drug).
Antiretroviral medications can cause a redistribution or accumulation of body fat and can raise cholesterol and other fat levels in the blood. The cause and long-term consequences of these effects are not well understood.
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