Treatment of AIDS can be frustrating both to the patient as well as to the doctor. The patient may be frustrated because it is a life-long affair and the doctor may be frustrated because he knows the treatment of AIDS does not cure the disease. After all, he knows it does not exterminate the HIV virus but merely keeps them from reproducing.
Treatment of aids has the following goals:
- To reduce the viral load to undetectable levels, i.e., less than 50 copies/milliliter, for as long as possible.
- To increase the count, if low, and maintain it in the normal range.
- To limit the development of resistance to medication.
- To restore the body’s immune system by raising the level of CD4 cells and to maintain it at that level.
- To prevent the patient acquiring opportunistic infections.
- To reduce transmission of the disease from the patient to others.
- To improve the quality of patient’s life and to extend its span,
Three groups of drugs are available for AIDS treatment:
- Nucleoside RTIs (NRTIs). Some examples with their dose follow:
- Azidothymidine (AZT), retrovir or Zidovudine (ZDV), 300 mg b.d.
- Didanosine (ddI), 200-350 mg b.d.
- Zalcitabine (ddC), 0.5 mg t.d.s.
- Stavudine (d4T), bd
- Lamirudine (3TC), 150 mg b.d.
- Non-nucleoside RTIs (NNRTIs). Examples are Nevirapine (NVP), dose, 20 mg/KG daily, and Delaviridine (DLV), dose, 400 mg t.d.s.
2. Protease Inhibitors (PIs). They inhibit protease. Normally protease fractures host’s proteins. The resultant fractions are necessary for the multiplication of HIV. The disabling of protease therefore prevents HIV replication. Examples with dose are given below:
- Saquinavir, 600 mg/day
- Indinavir, 800 mg t.d.s.
- Ritonavir, 600 mg b.d.
3. Fusion inhibitors (FIs). These drugs can be injected. They block HIV from entering the healthy cells of the body. Enfuvirtide (T-20) is a fusion inhibitor.
Evolution Of Aids Medication Regimens
Originally, monotherapy with ZDV was employed. This was associated with rapid development of resistance.
Later, two drugs were employed. Following were the different two drug combinations: (a) ZDV and 3TC; (b) ZDV and ddI; (c) Saquinavir and Ritonavir; and (d) Nelfinavir and d4T. These brought about an increase in the helper CD4 cell count and prevented opportunistic infections. However, the benefits were non-persistent and the problem of drug resistance remained.
Today, AIDS is treated with what is called ‘Highly Active AntiRetroviral Therapy’ (HAART). It is a triple cocktail therapy with two NRTIs such as ZDV and 3TC and one PI such as Indinavir. The key to the success of HAART lies in the drug combination’s ability to disrupt HIV replication at two different stages. NRTIs restrain an enzyme crucial to an early stage of HIV replication. PIs hold back another enzyme that functions near the end of the HIV replication process.
AIDS Drugs are not without side effects. The common ones are headache, rash, itching, anemia, hepatitis, neuropathy, hyperbilirubinemia and nephrolithiasis. They promote the onset of diabetes. In a diabetic, they worsen hyperglycemia. AIDS medicines may induce enhanced bleeding in people suffering from hemophilia types A or B.
Treatment of AIDS in the mother is done to prevent her spreading it to the fetus. This achieved by the following steps:
- AZT is given to the HIV infected pregnant women at 14 to 34 weeks of pregnancy by any one of these regimens:100 mg five times a day, 200 mg three times a day, or 300 mg twice a day.
- During labor and delivery, the mother receives intravenous AZT.
- The baby is treated with AZT (in liquid form) every 6 hours for 6 weeks after birth.
The maxim, what cannot be successfully treated should better be prevented, is very true with AIDS.