HIV: anti-retrovirals
Highly active anti-retroviral therapy (HAART) involves a combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). This combination both decreases viral replication but also reduces the risk of viral resistance emerging
Following the 2015 BHIVA guidelines it is now recommended that patients start HAART as soon as they have been diagnosed with HIV, rather than waiting until a particular CD4 count, as was previously advocated.
Nucleoside analogue reverse transcriptase inhibitors (NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Protease inhibitors (PI)
Following the 2015 BHIVA guidelines it is now recommended that patients start HAART as soon as they have been diagnosed with HIV, rather than waiting until a particular CD4 count, as was previously advocated.
Nucleoside analogue reverse transcriptase inhibitors (NRTI)
- examples: zidovudine (AZT), didanosine, lamivudine, stavudine, zalcitabine
- general NRTI side-effects: peripheral neuropathy
- zidovudine: anaemia, myopathy, black nails
- didanosine: pancreatitis
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
- examples: nevirapine, efavirenz
- side-effects: P450 enzyme interaction (nevirapine induces), rashes
Protease inhibitors (PI)
- examples: indinavir, nelfinavir, ritonavir, saquinavir
- side-effects: diabetes, hyperlipidaemia, buffalo hump, central obesity, P450 enzyme inhibition
- indinavir: renal stones, asymptomatic hyperbilirubinaemia
- ritonavir: a potent inhibitor of the P450 system