A human immunodeficiency virus (HIV) diagnosis is no
longer the death sentence it once was. Thirty years ago, doctors had little
more than comforting words to offer patients who had been diagnosed with the
virus. And while there remains no cure for HIV or AIDS, remarkable advancements
in treatments and clinical understanding of how the disease progresses are
allowing doctors to help their patients live longer, fuller lives. Here, the medicines
that are the future of HIV treatment.
Antiretroviral drugs do not cure HIV. Instead, they
suppress the virus and slow its progression in the body. Sometimes, they
suppress the virus to undetectable levels, but they do not eliminate the virus
from the body. If antiretroviral medication is successful, a person may be able
to add many healthy, productive years to his or her life. The person will still
be infected and capable of transmitting the virus, but he or she will be able
to maintain a higher health quality for a longer period of time. If the medications
are not effective, the virus will likely advance more quickly, and the patient
may reach the final stages of the infection in fewer years.
The most commonly prescribed U.S. Food and Drug
Administration (FDA)–approved antiretroviral medications can be divided into four
classes. These are:
- Reverse transcriptase (RT) inhibitors. RT
inhibitors interrupt the life cycle of an HIV-infected cell as it tries to
replicate itself. Two types of RT inhibitors exist: (1.) Non-nucleoside reverse transcriptase inhibitors
(NNRTIs) prevent HIV from making copies of itself. Common NNRTIs include
efavirenz (Sustiva), nevirapine (Viramune), and etravirine (Intelence). (2.) Nucleoside/nucleotide reverse transcriptase
inhibitors (NRTIs) keep HIV-infected cells from making copies of themselves
by interrupting the reconstruction of the disease’s DNA chain. The most common
NRTI is abacavir (Ziagen). The most common combination NRTIs are emtricitabine and
tenofovir (Truvada) and lamivudine and zidovudine (Combivir).
- Protease inhibitors
(PIs) disable protease, a protein HIV needs to make copies of itself. The
most common PIs include atazanavir (Reyataz), darunavir (Prezista), ritonavir
(Norvir), and fosamprenavir (Lexiva).
- Entry or
fusion inhibitors block HIV from entering CD4+ T-cells. These inhibitors
include maraviroc (Selzentry) and enfuviritide (Fuzeon).
inhibitors disable integrase, a protein that HIV uses to infect CD4+
T-cells. The most common integrase inhibitor is raltegravir (Isentress).
HIV cells can mutate and become resistant to a single
medicine. To avoid this, many doctors will prescribe a combination of medicines.
A combination of three or more antiretroviral drugs is called highly active antiretroviral
therapy (HAART), and it’s quickly becoming the initial treatment prescribed by
physicians for patients with HIV. When HAART was first approved by the FDA in
the late 1990s, HIV-related deaths in the United States were cut by more than
half within three years. Advances in medicine are also making adherence to
HAART much easier by reducing the number of pills a person must take and
reducing side effects. The most common HAART treatment consists of two NRTIs
and one NNRTI or a protease inhibitor.
In 2012, the FDA approved Stribild, a combination drug
that contains four different medications for treating HIV—the drug Truvada
(which contains both emtricitabine and tenofovir) and two new drugs,
elvitegravir (an integrase inhibitor) and cobicistat. Stribild is one of the
first complete regimen treatments for HIV—it’s a single pill, taken once daily,
and it cannot be combined with other HIV medications. Together, these four
medicines prevent HIV from replicating and lower the overall viral load in the
In 2011, a similar drug, Complera, was introduced and
made available for patients with HIV. This single, once-daily pill contains a
combination of emtricitabine, rilpivirine, and tenofovir.
Though a promising advancement, not every patient with
HIV is qualified to take these combination pills. Talk with your doctor to see
if you are, or how you can become qualified.
Drugs on the
Each year, new therapies are finding stronger and
stronger ground as the future for treating and possibly curing HIV/AIDS. A drug
class known as maturation inhibitors may potentially prevent HIV from maturing
and properly developing. If these drugs work as designed, they could block HIV
from merging with healthy cells.