18th June 2024

HIV Treatment

Advances in antiretroviral therapy (ART) have transformed HIV into a manageable condition with an overall-normal life expectancy, provided the disease is promptly diagnosed and the treatment regimen is rigidly adhered to. Following the results of the INSIGHT START Trial in 2015, rather than waiting for the CD4+ count to fall to a certain threshold, ART is now recommended to commence as soon as possible. Typical regimens contains three drugs, usually two nucleoside reverse transcriptase inhibitors (NRTIs) (e.g. tenofovir disoproxyl fumarate, emtricitabine) plus a third agent belonging to one of the following categories:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): commonly selected agents, earlier generations are associated with neuropsychiatric side effects. Examples include efavirenz and rilpivirine
• Protease inhibitors (PIs): agents with high barriers to resistance, however a common cause of drug-drug interactions and diarrhoea.  Examples include darunavir and lopinavir
• Integrase strand transfer inhibitors (ISTIs): very well-tolerated agents with a high barrier to resistance. They are becoming increasingly popular. Examples include dolutegravir and bictegravir