LATEST TREATMENT IN HIV-AIDS

Goals of Therapy & Tools to Achieve Goals


* Improvement of quality of life
* Reduction of HIV-related morbidity and mortality
* Restoration and/or preservation of immunologic function
* Maximal and durable suppression of viral load
* Selection of ARV regimen
* Preservation of future treatment options
* Rational sequencing of therapy
* Maximizing adherence
* Use of resistance testing in selected clinical settings

Considerations for Discontinuing Therapy


* Patients begun on HAART at CD4 count >350 cells/µL
* No clinical data on safety of treatment discontinuation
* Potential benefits: decreased toxicity, drug interactions, and drug resistance
* Potential risks: rebound in viral replication, immunologic deterioration



Current Antiretroviral Medications
NRTI

* Abacavir ABC
* Didanosine DDI
* Emtricitabine FTC
* Lamivudine 3TC
* Stavudine D4T
* Zidovudine ZDV
* Zalcitabine DDC
* Tenofovir TDF

NNRTI

* Delavirdine DLV
* Efavirenz EFV
* Nevirapine NVP

PI

* Amprenavir APV
* Atazanavir ATV
* Fosamprenavir FPV
* Indinavir IDV
* Lopinavir LPV
* Nelfinavir NFV
* Ritonavir RTV
* Saquinavir SQV
* soft gel SGC
* hard gel HGC
* tablet INV
* Tipranavir TPV

ANTIRETROVIRAL COMPONENTS IN INITIAL THERAPY

NNRTIs



ADVANTAGES

* Less dyslipidemia and fat maldistribution than in PI-based regimens
* PI options preserved for future use

DISADVANTAGES

* Resistance - single mutation
* Cross-resistance among NNRTIs
* Rash; hepatotoxicity
* Potential drug interactions (CYP450)

PIs



ADVANTAGES

* Longest prospective data
* NNRTI options preserved for future use

DISADVANTAGES

* Metaboliccomplications (fat maldistribution, dyslipidemia, insulin resistance)
* Greater potential for drug interactions (CYP450), especially with ritonavir

NRTIs



ADVANTAGES

* Established backbone of combination therapy
* Minimal drug interactions
* PI and NNRTI preserved for future use

DISADVANTAGES

* Lactic acidosis and hepatic steatosis reported with most NRTIs (rare)
* Triple NRTI regimens show inferior virologic response compared with efavirenz- and indinavir-based regimens*

Treatment-Experienced Patients: ARV Treatment Failure

* Causes of treatment failure include:
* Patient factors(CD4 nadir, VL, comorbidities, etc)
* Suboptimal adherence
* ARV toxicity and intolerance
* Pharmacokinetic problems
* Suboptimal drug potency
* Viral resistance