The Importance of Antiretroviral Agents

Antiretroviral therapy slows the progression of HIV, and it somewhat protects the patient from development of AIDS [1, 2].  As this chronic medical condition gradually damages the human immune system over many years, these drugs will lessen the severity of that process.  Though recommendations have been to initiate these agents when the CD4 cell count falls to 350 per cubic millimeter, that decision depends on many factors [1, 2]. 

Patients with kidney problems in the presence of this disease, or HIV-associated nephropathy (HIVAN), require therapy regardless of the CD4 cell count [2].  Those who have symptoms from the infection also need to begin treatment irrespective of the CD4 cell count.  Additionally, those who have opportunistic infections or other evidence of AIDS must take medication in order to afford the best prognosis [1.2]. 

It is also true that those who acquire viral hepatitis, whether type B or C, may necessitate antiretroviral therapy whenever HIV infection is also present.  These cases of hepatitis with HIV coinfection may occur because both diseases can transmit through shared needles for injection drug use.  Furthermore, hepatitis B and HIV transmit through sex.  Essentially, some antiretroviral agents will treat both diseases [2]. 

Some clinicians have long believed that early initiation of therapy prevents consequences of HIV in a better fashion than the use of 350 per cubic millimeter as the decision point.  They maintain this position despite side effects which some of the drugs may have in certain patients [2]. 

Noncompliance with antiretroviral medication may lead to viral resistance, and the patient's viral load in the bloodstream may rise to excessive levels.  Good control over the HIV RNA level lowers the risk that the disease will transmit to HIV-negative partners.  These agents have also dramatically reduced the occurrence of mother-to-child transmission of HIV during pregnancy, labor, or delivery [1.2].

Neither a cure nor satisfactory vaccine is available today.  However, progress with antiretroviral drug research has been enormous since the epidemic began 30 years ago, and scientists expect that patients with HIV can live for 30 to 40 years when they take these drugs [2]. 

References

1.  Centers for Disease Control.  (2012).  Act Against AIDS.  Retrieved April 15, 2013.

2.  U.S. Department of Health and Human Services.  (2011).  HIV/AIDS.  Retrieved April 15, 2013.

3.  The photograph is a thin-section transmission electron micrograph of several human immunodeficiency virus particles.  Reprinted with permission from Centers for Disease Control/Dr. A. Harrison/Dr. P. Feorino.

The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.