Management of HIV

ART (Anti-Retroviral Therapy) is the standard HIV treatment, using a combination of medicines (usually 2 or more from different drug classes) to stop the virus from multiplying.  The medications also keep the immune system strong and prevents virus transmission.  The ART is often either in single daily PILLS such as Biktarvy (which contains Bictegravir / Emtricitabine / Tenofovir) and Dovato (which contains Dolutegravir / Lamivudine) or INJECTIONS such as Cabenuva (which contains Cabotegravir / Rilpivirine). 

How do the different ART Medication Drug Classes work ;

• Integrase Inhibitors block HIV from integrating its DNA into host cells.  (Examples of these medications include Bictegravir and Dolutegravir)
• Nucleoside / Nucleotide Reverse Transcriptase Inhibitors (NRTI / NtRTI) stop HIV from copying its genetic material (Examples of these medications include Tenofovir, Emtricitabine and Lamivudine)
• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) block reverse transcriptase. (Examples of these include Doravirine, Efavirenz, Nevirapine and Rilpivirine)
• Protease Inhibitors (PIs) stop HIV from creating new virus particles (Examples of these medications include Atazanavir, Darunavir, Fosamprenavir, Indinavir, Nelfinavir, Ritonavir, Saquinavir and Tipranavir)
• Entry / Fusion Inhibitors prevent the virus from entering cells (Examples of these medications include Enfuvirtide and Fostemsavir)

Treatment Goal of HIV Therapy

The goal of HIV treatment is to reduce HIV to an undetectable level in the blood to prevent disease progression and sexual transmission (Hence the term, U=U: Undetectable = Untransmittable).

Common Treatment Regimes

• Single-Pill Options : Most people take one pill daily (which contains a mixture of drugs) such as Biktarvy or Dovato
• Injectables : Injection of Cabenuva (which contains Cabotegravir / Rilpivirine) can be given every 1 or 2 months

Side-effects of ART Treatment

Common but mild side-effects include nausea and vomiting, diarrhoea, mood changes or depression, difficulty sleeping, headaches, dry mouth and weight gain.  More serious side-effects (which occur in less than 10% and who may be required to stop treatment) include hypersensitivity or allergic reactions, liver or kidney toxicity. 

Tracking Progress on Treatment

Plasma levels of viral RNA have been shown to correlate with clinical outcomes, including overall mortality, and measurement of HIV-RNA levels provides the most precise means of establishing whether a response to Anti-Retroviral Therapy (ART) has occurred.  It is important that patients are MONITORED regularly by their treating doctors to ensure their treatment is working well.

Prognosis

With the success of ART, the life expectancy of people with HIV is approaching that of people without HIV. As a result, many people with HIV are now experiencing age-related health conditions such as cardiovascular diseases and metabolic complications (such as weight gain, diabetes, dyslipidaemia, steatotic fatty liver disease or osteoporosis). Although a significant CD4 count increase often occurs among patients treated with effective ART, the absence of such an increase should not be interpreted as treatment failure if the viral load declines appropriately.

• When patients have a CD4 count ≥ 350 cells/mm3 at the start of treatment, there is a high likelihood of sustaining a CD4 count > 200 cells/mm3 during that period of time
• When patients have sustained viral suppression and CD4 counts between 100-200 cells/mm3, they have a very low risk of developing infections such as pneumocystis pneumonia

ALWAYS follow-up with your Treating Doctor during your Treatment to ensure good outcome

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