### Date : 2024-06-20 08:17 ### Topic : Antiretroviral therapy (ART) #medicine #virus #infectology ---- ### Antiretroviral Therapy (ART) Overview **Antiretroviral Therapy (ART)** is the use of a combination of medications to treat HIV (Human Immunodeficiency Virus) infection. ART helps manage HIV infection, improves the quality of life for those infected, and reduces the risk of HIV transmission. ### Goals of ART 1. **Suppress Viral Load:** Reduce the amount of HIV in the blood to undetectable levels. 2. **Restore and Preserve Immune Function:** Increase and maintain the number of CD4 cells (T cells) to fight off infections and diseases. 3. **Reduce HIV-related Morbidity and Mortality:** Decrease the occurrence of HIV-related complications and improve overall survival. 4. **Prevent HIV Transmission:** Reduce the risk of transmitting the virus to others. ### Classes of Antiretroviral Drugs ART typically involves a combination of drugs from different classes to ensure maximum effectiveness and prevent resistance. The main classes include: 1. **Nucleoside Reverse Transcriptase Inhibitors (NRTIs):** - Block reverse transcriptase, an enzyme HIV needs to replicate. - Examples: Zidovudine (AZT), Lamivudine (3TC), Emtricitabine (FTC), Tenofovir (TDF). 2. **Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs):** - Bind to and inhibit reverse transcriptase, preventing HIV replication. - Examples: Efavirenz (EFV), Nevirapine (NVP), Rilpivirine (RPV). 3. **Protease Inhibitors (PIs):** - Inhibit protease, an enzyme HIV uses to assemble new virus particles. - Examples: Lopinavir/ritonavir (LPV/r), Atazanavir (ATV), Darunavir (DRV). 4. **Integrase Strand Transfer Inhibitors (INSTIs):** - Block integrase, an enzyme HIV uses to integrate its genetic material into the host's DNA. - Examples: Raltegravir (RAL), Dolutegravir (DTG), Bictegravir (BIC). 5. **Entry Inhibitors:** - Prevent HIV from entering human cells. - Examples: Maraviroc (MVC) blocks the CCR5 co-receptor; Enfuvirtide (T-20) is a fusion inhibitor. 6. **Post-Attachment Inhibitors:** - Block HIV from entering the host cell after it has attached to the CD4 receptor. - Example: Ibalizumab (IBA). ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 32 - **Occupation:** Office Worker - **HIV Diagnosis:** Recently diagnosed with HIV **Initial Evaluation:** - **CD4 Count:** 350 cells/mm³ - **Viral Load:** 50,000 copies/mL **Recommended ART Regimen:** - **Combination Therapy:** - **NRTIs:** Tenofovir disoproxil fumarate (TDF) + Emtricitabine (FTC) - **INSTI:** Dolutegravir (DTG) **Follow-Up Plan:** - **Monitoring:** Regular follow-up visits to monitor viral load, CD4 count, and potential side effects. - **Adherence Support:** Counseling on the importance of medication adherence to prevent resistance and ensure effectiveness. ### Implementation and Management 1. **Starting ART:** - Initiate ART as soon as possible after diagnosis to control viral replication and improve immune function. 2. **Adherence to Therapy:** - Emphasize the importance of taking medications consistently as prescribed to achieve and maintain viral suppression. - Address potential barriers to adherence, such as side effects, pill burden, and lifestyle factors. 3. **Monitoring and Adjusting Treatment:** - **Regular Blood Tests:** Monitor viral load and CD4 count to assess the effectiveness of therapy. - **Side Effects Management:** Manage side effects to improve adherence and quality of life. - **Resistance Testing:** Perform resistance testing if the viral load increases, indicating potential drug resistance. 4. **Managing Side Effects:** - **Short-Term Side Effects:** May include nausea, fatigue, headaches, and diarrhea. - **Long-Term Side Effects:** Potential issues such as lipodystrophy, bone density loss, kidney dysfunction, and cardiovascular effects. 5. **Preventive Care:** - **Vaccinations:** Keep up to date with vaccines, such as influenza, pneumococcal, and hepatitis B. - **Regular Health Screenings:** Monitor for other health conditions, including tuberculosis, sexually transmitted infections, and cancers. 6. **Psychosocial Support:** - **Counseling:** Provide psychological support and counseling to address mental health issues and improve overall well-being. - **Support Groups:** Encourage participation in support groups for peer support and education. ### Conclusion Antiretroviral therapy (ART) is the cornerstone of HIV management, significantly improving the prognosis and quality of life for people living with HIV. Early initiation, adherence to therapy, regular monitoring, and comprehensive care are essential components of successful HIV treatment. Through effective ART, individuals with HIV can achieve undetectable viral loads, maintain a healthy immune system, and reduce the risk of transmission to others.