Examples
|
| delavirdine | Rescriptor |
| efavirenz | Sustiva |
| etravirine | Intelence |
| nevirapine | Viramune |
| rilpivirine | Edurant |
Combination medicines
|
| efavirenz, emtricitabine, tenofovir | Atripla |
| emtricitabine, rilpivirine, and tenofovir | Complera |
These medicines may be available in other combinations to
treat HIV infection.
How It Works
Nonnucleoside reverse transcriptase
inhibitors (NNRTIs) are antiretroviral medicines. They prevent the human
immunodeficiency virus (HIV) from multiplying. When the amount
of virus in the blood is kept at a minimum, the
immune system has a chance to recover and grow
stronger.
Why It Is Used
The use of three or more
antiretroviral medicines (highly active antiretroviral therapy, or HAART) is the usual treatment for HIV infection.
The
combination of medicines used for HAART will depend on your health, other
conditions you might have (such as
hepatitis), and results of testing. Talk to your
doctor about the best treatment plan for you.
Treatment guidelines
suggest the following for people with HIV:1, 2, 3
- Experts currently consider your CD4+ count and presence or
absence of symptoms more important than your viral load, when considering
treatment.
- If your
CD4+ count is below 500 cells per microliter (mcL),
treatment is recommended to help keep your immune system healthy and to
prevent AIDS.
- If your CD4+ cell count is greater than 500, you may want to think about starting treatment.
- If treatment is not started, your condition will be
monitored with frequent CD4+ cell counts.
- If you have symptoms of
HIV or AIDS, doctors recommend starting treatment, whatever your CD4+ count
is.
- If you are pregnant, you should be treated to prevent your unborn
baby (fetus) from becoming infected with HIV.
- If
you also have
hepatitis B and are starting treatment for it, you
should begin treatment for HIV also.
You may also want to start HIV treatment if your sexual partner does not have HIV. Treatment of your HIV infection can help prevent the spread of HIV to your sexual partner.3
The U.S. National Institutes of Health recommends one of the following programs for people who start treatment for HIV:1
- Efavirenz + tenofovir + emtricitabine
- Ritonavir-boosted atazanavir + tenofovir + emtricitabine
- Ritonavir-boosted darunavir + tenofovir + emtricitabine
- Raltegravir + tenofovir + emtricitabine
HIV: When Should I Start Antiretroviral Medicines for HIV Infection?
HIV: Taking Antiretroviral Drugs
How Well It Works
When compared with people who are
given single- or double-medicine therapy, people who are given triple-medicine
therapy (HAART):
- Have a greater reduction in viral
load.
- Have better immune system recovery (measured by increased
CD4+ cell counts).
- Are less likely to develop
resistance to their medicines.
- Are likely
to live longer.
Antiretroviral therapy can also decrease symptoms of HIV
infection, such as fever, weakness, and weight loss.
The rate at
which antiretrovirals decrease viral loads is affected by:1
- CD4+ cell counts at the start of
treatment.
- Viral load at the start of
treatment.
- The dosage of the medicines.
- Whether
medicines are taken exactly as prescribed.
- Whether antiretroviral
medicines have been taken before.
- Whether
opportunistic infections are present.
Side Effects
Side effects of nonnucleoside reverse transcriptase inhibitors can include:
- Headache.
- Nausea,
vomiting, and diarrhea.
- Rash.
- Dizziness.
- Vivid dreams and trouble sleeping.
In rare cases, nevirapine causes liver damage that can
be severe and life-threatening. Regular blood tests may be needed to watch
for liver problems.
Etravirine can cause a rare, but severe, skin reaction.
Side effects of any combination medicine can include the
side effects of any of the single medicines in the combination.
Side effects usually are not as bad after your body has adjusted to the
medicine. Report all side effects to your doctor. He or she may be able to help
you reduce side effects by giving you other medicines.
See Drug
Reference for a full list of side effects. (Drug Reference is not available in
all systems.)
What To Think About
Resistance to single-medicine
NNRTI treatment develops quickly. For this reason, they should be used only in
combination with other antiretroviral medicines to treat HIV infection or to
prevent or delay the development of resistance.
Things to think about when choosing a combination of medicines
include:
- The ability of the medicines to reduce your
viral load.
- The likelihood that you will develop resistance to the
medicines. If you have already been treated with a certain antiretroviral
medicine, you may already know whether you are resistant to medicines in that
class.
- Side effects and your willingness to tolerate
them.
- The cost of treatment.
Many people think that antiretroviral medicines always have
severe side effects. In fact, only a few people experience severe side
effects.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
- U.S. Department of Health and Human Services (2009). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available online: http://www.aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf.
- Hammer, Scott M, et al. (2008). Antiretroviral
treatment of adult HIV infection: 2008 recommendations of the International
AIDS Society USA Panel. JAMA, 300 (5):
555–570.
- U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2011). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Peter Shalit, MD, PhD - Internal Medicine |
|---|
| Last Revised | October 17, 2011 |
|---|
U.S. Department of Health and Human Services (2009). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available online: http://www.aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf.
Hammer, Scott M, et al. (2008). Antiretroviral
treatment of adult HIV infection: 2008 recommendations of the International
AIDS Society USA Panel. JAMA, 300 (5):
555–570.
U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2011). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
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