Examples
|
| abacavir | Ziagen |
| didanosine, also known as dideoxyinosine, ddI | Videx |
| emtricitabine | Emtriva |
| lamivudine (3TC) | Epivir |
| stavudine (d4T) | Zerit |
| tenofovir | Viread |
| zidovudine (ZDV), formerly known as azidothymidine (AZT) | Retrovir |
Combination medicines
|
| abacavir and lamivudine | Epzicom |
| abacavir, lamivudine, and zidovudine | Trizivir |
| emtricitabine and tenofovir | Truvada |
| emtricitabine, efavirenz, and tenofovir | Atripla |
| emtricitabine, rilpivirine, and tenofovir | Complera |
| zidovudine and lamivudine | Combivir |
These medicines may be available in other combinations to
treat HIV infection.
How It Works
Nucleoside/nucleotide reverse
transcriptase inhibitors 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
- When considering treatment, experts currently consider your CD4+
cell count and the presence or absence of symptoms more important than your
viral load.
- If your
CD4+ cell 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 consider 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+ cell
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 as well.
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 begin 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
Zidovudine (ZDV), either alone or in combination with other
antiretrovirals, is recommended for HIV-infected women who are more than 12
weeks pregnant, to prevent HIV from spreading to the fetus. The baby should
also receive treatment for 6 weeks after birth.
How Well It Works
Combination therapy:
- Reduces viral loads, which can lead to stable
or increased CD4+ cell counts, a sign that the immune system is still able to
fight off
opportunistic infections.
- Decreases the
number and severity of opportunistic infections.
- Reduces or
prevents
resistance to the medicines.
- Prolongs
life.
Antiretroviral therapy can also reduce symptoms of HIV
infection, such as fever, weakness, and weight loss.
Zidovudine
(ZDV), either alone or in combination with other antiretrovirals, reduces the
risk of the spread of HIV from an infected mother to her baby.1
The rate at which antiretrovirals decrease viral
loads is affected by:1
- CD4+ cell counts at the beginning of
treatment.
- Viral load at the beginning of
treatment.
- The dosage of the medicines.
- Whether the
medicines are taken exactly as prescribed.
- Whether antiretroviral
medicines have been taken before.
- Whether any
opportunistic infections are present.
Side Effects
Side effects of nucleoside/nucleotide reverse transcriptase inhibitors may include:
- Headache.
- Changes in the distribution of body fat.
- Nausea, vomiting, and diarrhea.
- Numbness, tingling, and painful sensations in the hands
and feet (peripheral neuropathy).
- Severe
fatigue.
- Kidney problems.
A serious, potentially life-threatening
allergic reaction occurs in a small number of people
who take abacavir. A screening test (HLA-B*5701 test) is available
to help predict who may have a serious reaction to abacavir.4 The U.S. Department of Health and Human Services (DHHS)
recommends that anyone who may receive abacavir should get tested for
sensitivity to it first.1
Didanosine may cause inflammation of the pancreas (pancreatitis). This can lead to belly pain and
vomiting. This side effect is more common in people who drink alcohol
heavily. In rare cases, didanosine can also cause serious liver damage.
Rarely, emtricitabine causes severe
liver problems.
People who are infected with hepatitis B may have
a flare-up of the illness if they suddenly stop taking certain nucleoside/nucleotide reverse transcriptase inhibitors.
Side effects of any combination medicine can include
the side effects of any of the single medicines in the combination.
Report all side effects to your doctor at your next visit. He or she can
adjust your dose or give you other medicines to reduce side effects. Some mild
side effects, such as nausea, improve as your body adjusts to the
medicine.
See Drug Reference for a full list of side effects.
(Drug Reference is not available in all systems.)
What To Think About
Factors to consider when choosing
a combination of medicines include:
- The ability of the medicines to reduce your
viral load.
- The likelihood that the virus will develop resistance
to a certain class of medicine. If you have already been treated with an
antiretroviral medicine, you may already know whether you are resistant to
medicines in that class.
- Side effects and your willingness to
tolerate them.
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.
- Mallal S, et al. (2008). HLA-B*5701 screening for
hypersensitivity to abacavir. New England Journal of Medicine, 358(6): 568–579.
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.
Mallal S, et al. (2008). HLA-B*5701 screening for
hypersensitivity to abacavir. New England Journal of Medicine, 358(6): 568–579.
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