Antiretroviral Therapy (ART)

Antiretroviral therapy (ART) is a treatment for HIV infection that uses a combination of medications to suppress the virus and prevent its progression to AIDS.

How ART Works

ART works by targeting different stages of the HIV life cycle, including:

• Reverse transcription: Medications such as nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) block the virus's ability to convert its genetic material into DNA.
• Integration: Integrase strand transfer inhibitors (INSTIs) prevent the virus from integrating its genetic material into the host cell's DNA.
• Protease inhibition: Protease inhibitors (PIs) block the virus's ability to produce new viral particles.
• Entry inhibition: Entry inhibitors, such as fusion inhibitors and CCR5 antagonists, prevent the virus from entering host cells.

Types of ART Regimens

There are several types of ART regimens, including:

• First-line regimens: These regimens are used to treat individuals who have not previously received ART. Examples include tenofovir disoproxil fumarate (TDF) + emtricitabine (FTC) + efavirenz (EFV).
• Second-line regimens: These regimens are used to treat individuals who have failed first-line therapy. Examples include zidovudine (ZDV) + lamivudine (3TC) + lopinavir/ritonavir (LPV/r).
• Salvage regimens: These regimens are used to treat individuals who have failed multiple previous ART regimens.

Benefits of ART

The benefits of ART include:

• Viral suppression: ART can suppress the virus to undetectable levels, reducing the risk of transmission and slowing disease progression.
• Improved immune function: ART can help restore the immune system by increasing CD4 cell counts.
• Reduced morbidity and mortality: ART has been shown to reduce the risk of opportunistic infections, cancers, and death.
• Prevention of mother-to-child transmission: ART can prevent the transmission of HIV from mother to child during pregnancy, childbirth, and breastfeeding.

Risks and Side Effects of ART

The risks and side effects of ART include:

• Medication toxicity: Certain medications used in ART can cause toxicities such as liver damage, kidney damage, and bone marrow suppression.
• Resistance: The development of resistance to ART medications can reduce their effectiveness.
• Adverse effects: Common adverse effects of ART include nausea, vomiting, diarrhea, and rash.
• Drug interactions: ART medications can interact with other medications, reducing their effectiveness or increasing the risk of side effects.

Monitoring and Adherence

Regular monitoring and adherence to ART are crucial for its success. This includes:

• Viral load testing: Regular viral load testing is used to monitor the effectiveness of ART and detect any potential resistance.
• CD4 cell count monitoring: CD4 cell counts are used to monitor immune function and adjust treatment as needed.
• Adherence counseling: Adherence counseling is essential to ensure that individuals take their medications as prescribed and understand the importance of adherence.