ANTI-RETROVIRAL TREATMENT (ART) OF HUMAN IMMUNO-DEFICIENCY VIRUS (HIV)

Edited by, JASPER VICTORIA

Human Immuno-deficiency Virus (HIV) is the causative agent of Acquired Immuno-Deficiency Syndrome (AIDS). HIV infects the CD4+ T-lymphocytes and macrophages, weakening the immune system and exposing the host to opportunistic infections and keep on replicating in them all resulting in immune system dysfunction-AIDS.

ANTI-RETROVIRAL THERAPY (ART)

The anti-retroviral therapy of HIV usually consists of 2 Nucleoside Reverse Transcriptase Inhibitors (NRTI) along with one of the following:

1)Ritonavir-boosted protease inhibitor

2)NNRTI

3)Integrase inhibitor

The following are the mechanism of action of the antiretroviral drugs:

CCR5 Antagonists: Chemokine Receptor 5 (CCR5) antagonists work by blocking the CCR5 co-receptor and hence inhibit the entry of the virus into the host.

Nucleos(t)ide and Non-Nucleoside Reverse Transcriptase Inhibitors (NRTIs and NNRTIs): they prevent the conversion of viral RNA to DNA by inhibition of enzyme reverse transcriptase.

Integrase Strand Transfer Inhibitors (INSTIs): They prevent the HIV DNA integration into the host cell nucleus by inhibition of enzyme integrase.

Protease Inhibitors (PIs): They prevent the maturation of the viral particles by inhibition of enzyme protease.

Pharmacokinetic boosters / enhancers: enhance, boost or increase the effectiveness of the anti-retroviral drugs even at lower doses.

The first line drugs include:

NRTI combinations:

Tenofovir and emtricitabine

Abacavir and lamivudine

Protease inhibitors: Atazanavir, darunavir.

NNRTI: Rilpivirine, efavirenz.

Integrase inhibitor: Dolutegravir, elvitegravir, raltegravir.