Antiretroviral therapy and its impact on the health of patients with HIV. A new class is protease inhibitors. Integration of used drugs

Plays an important role. It is prescribed only by a qualified doctor based on tests, other clinical and laboratory studies, as well as the general condition of the patient. Of course, it is impossible to cure the disease completely with its help. But to alleviate the patient's condition and significantly extend his life - completely. Antiretroviral therapy is most commonly used for HIV infection. It implies an impact on several problems at once, which are carried by the immunodeficiency virus. When is such treatment used, and what types does it consist of?

HIV infection, ART therapy: general information

Therapy for AIDS has been developed for several decades. To date, it is high antiretroviral that is recognized as the most effective. Before describing its effectiveness and direction, it is necessary to find out when such treatment is started and for whom it is needed. It is known that antiretroviral therapy for HIV infection is not applied immediately after diagnosis. It would seem that an infected person should be treated immediately. But it is not. With such a diagnosis, it is very important not to harm the body with strong drugs. It is worth noting that approximately thirty percent of all those infected are carriers of the virus. They do not have an acute stage of the disease, and the incubation period immediately turns into a latent one, which lasts for decades. In such people, a terrible illness is diagnosed, as a rule, by chance, for example, in preparation for a planned operation, medical examination, and so on.

Taking HIV therapy in this case is considered inappropriate. Since the body does not respond to the presence of an infectious agent in it. The use of strong drugs can cause a weakening of the immune system. In some cases, this can backfire. Then a person from a carrier of the virus will turn into an infected person with all the accompanying symptoms. AIDS therapy is not used even in the asymptomatic stage. We are also talking about patients in whom the acute stage appears "in all its glory." Treatment in their case directly depends on how the infected organism behaves.

Throughout the latent stage, such patients regularly visit a doctor and take tests. The decision on whether antiretroviral therapy for HIV is necessary in each case is made by a specialist based on some research. What is taken into account when making such a decision? viral load. With regular sampling of tests in an infected patient, the viral load per milliliter of blood is determined. While it is within the normal range, the asymptomatic stage continues. An organism with strong immunity manages to produce the right amount of antibodies that resist the virus. In this case, therapy for HIV infection is not needed.

In addition to the viral load, the immune status is also taken into account. We are talking about the quantitative composition of CD-4 cells. It is also determined through blood sampling. There are cases when the immune status and viral load are normal, but the patient gradually begins to show signs of secondary manifestations. This includes both comorbidities and opportunistic infections. In these cases, antiviral and retroviral therapy for HIV is necessary. And the sooner treatment begins, the better the prognosis. It is important to take into account that when deciding on the appointment of certain drugs, the doctor necessarily looks at the dynamics of the immune status and viral load. The specialist needs to analyze how the patient's condition changes over several months.

Based on the monitoring of the state of the immune system, a decision is made on what kind of therapy for HIV-infected people is necessary at this stage of the course of the disease. Only a doctor should prescribe treatment. After all, for each patient, it is selected depending on the characteristics of the body and the results of the tests.

HIV - therapy regimens: antiviral, immune and clinical orientations

It should be noted that HAART therapy used in HIV has several goals at once. It has a virological, general strengthening immune and clinical focus. Each of them should be considered in more detail. Antiretroviral drugs for HIV are taken in combination. The doctor prescribes several medicines to the patient at once. Usually we are talking about three or four drugs. Virological agents for HIV and AIDS are prescribed as a therapy that pursues not only the goal of suppressing the immunodeficiency virus itself.

As a rule, antiviral drugs are also needed in order to reduce the impact on the body of concomitant diseases, if they have already manifested themselves. If the doctor decides to use such drugs even at the asymptomatic stage, then the patient needs a powerful course of medications that suppress infected cells. Most often, such a need arises when the viral load significantly exceeds the norm. In this case, one cannot do without treatment, which implies such AIDS therapy.

So, the main task of the antiviral effect on the body of an infected person is to reduce the production of infected cells and reduce their spread. The course of such antiviral therapy for HIV lasts, as a rule, from sixteen to twenty-four weeks. In this case, the effect of suppression can be observed as early as the sixth week.

Immunological initiation therapy for HIV is necessary in order to restore the immune system. She suffers greatly with an increase in viral load. The immune status at the same time does not correspond to the norm. Taking drugs that restore the immune system allows you to increase the number of CD-4 cells to normal.

Clinical ART therapy for HIV includes drugs that can extend the life of infected patients not by a year or two, but by decades. At times, the risk of developing AIDS, which, as you know, quickly ends in death, is reduced. With this HIV treatment, HAART makes it possible for infected partners to conceive a child relatively safely. The risk of transmitting the virus through blood or through sexual contact is also reduced.

The initiation and side effects of HIV therapy are closely related

It is the specialist who decides when to start therapy for HIV, therefore, immediately after the diagnosis, you need to go to a specialized hospital. However, the effectiveness of treatment largely depends on the person's lifestyle and adherence to medical prescriptions, and, of course, on what kind of therapy is prescribed for HIV. Here are a few helpful tips to help infected individuals start the treatment prescribed by their doctor:

It should be remembered once again that adherence to HAART for HIV infection is one of the important components of successful treatment.

Side effects and consequences of HIV therapy

HAART is a highly effective treatment, with the help of which the latent period of the immunodeficiency virus can last for decades, and AIDS does not develop at all. However, this approach to maintaining and restoring an infected organism, unfortunately, is not ideal. All drugs, the use of which he implies, are toxic. Of course, this affects the internal organs and vital systems of the human body. That is why, before AIDS-preventing antiretroviral therapy is prescribed, the patient must undergo a lot of examinations and pass the necessary tests. This is necessary so that the attending physician can choose the most appropriate scheme. Regular visits to a specialist and a clear clinical picture will help the patient successfully balance the line between suppressing the virus and the harm that drugs can cause.

Doctors, when prescribing therapy for HIV, always warn the patient about possible side effects. This is extremely important, if only so that the patient can distinguish the consequences of taking drugs with dangerous symptoms that can occur if the effectiveness of the treatment decreases. It is important to note here that antiretroviral therapy for HIV-infected patients is a treatment that is well tolerated by most patients. Although it is often compared to chemotherapy, side effects from its use are much less frequent and much easier.

Nausea and vomiting are the most common signs of a reaction to HAART. They can haunt the patient constantly or appear only occasionally. As a rule, nausea and vomiting appear in the first weeks of treatment. The doctor should warn the patient about this when it will be necessary to start therapy for HIV.

Another common side effect is diarrhea. It occurs due to the fact that drugs for the treatment of the immunodeficiency virus disrupt the flora in the intestine. That is why, in HIV therapy, the effects on the intestines should be eliminated by taking prebiotics. On the part of the gastrointestinal tract during the use of such drugs, there may also be anorexia, pain in the epigastric region. If the patient had an undiagnosed ulcer, then such treatment can cause stomach bleeding.

Side effects of HIV therapy can also be observed in the central nervous system. This is a rather rare phenomenon, which occurs in only five percent of those infected.

There are a number of contraindications for HAART. So, for example, alcohol should not be taken at least a few days before it starts. It is not used in acute renal failure or gastric bleeding. ART therapy for HIV should only be initiated with fever if it is a consequence of one of the comorbidities. If this symptom manifested itself due to a disease that is not related to the immunodeficiency virus, then it should be eliminated before starting treatment.

Gene therapy for HIV 2016: effective or not?

Gene therapy for the immunodeficiency virus has been developed relatively recently. In 2016, it was adopted by some clinics in our country. Such HIV therapy is expensive in Russia, while its effectiveness is little trusted by some specialists qualified in the treatment of the immunodeficiency virus. Perhaps the reason is that not too much research has been done on the new method. Whether gene therapy helps with HIV is a question that is still difficult to answer.

It is based on the use of enzymes that remove infected tissue from the body. Some scientists believe that such a method of treatment can cause irreversible consequences. After all, intervention in the body at the gene level is always unpredictable. What is the best HAART therapy for HIV infection should be decided by a qualified specialist.

Physiotherapy for HIV Infection and Other Alternative Therapies

Physio-methods are not used as a treatment for the immunodeficiency virus. This type of therapy can be used to alleviate the symptoms of diseases caused by damage to the central nervous system.

Psychotherapy for HIV infection brings tangible results. Some patients need it, because it is extremely difficult to live with such a diagnosis. Much depends on the psychological state of the patient, including how HAART will affect his body.

Some private clinics today offer a service such as ozone therapy for HIV infection. Qualified specialists consider it insufficiently effective.

The human immunodeficiency virus belongs to the lentivirus subfamily of the retrovirus family. There are two types of virus that differ in genome structure and serological characteristics: HIV-1 and HIV-2. Globally, between 30 and 50 million people are estimated to be infected with HIV, and most of them should be expected to die within the next 10 years, with each likely infecting several dozen more people. Since 1996, there has been a massive spread of HIV infection in Russia. During 2000-2001 HIV infection spread to almost the entire territory of Russia, and the increase in the number of newly registered cases in 2000 amounted to more than 85 thousand. The number of registered cases of HIV infection among Russian citizens by the beginning of 2002 amounted to more than 180 thousand people.

In the last decade, there has been significant progress in the field of HIV infection therapy, primarily due to the emergence of new classes of ARVs and new drugs. The rapid introduction of new drugs, the revision of treatment tactics, the development of new treatment regimens determine the need for frequent revision of international and national guidelines in this area of ​​clinical practice. Keeping abreast of the latest developments in this area allows you to study the relevant manuals and books posted on the Internet for free at the following addresses:

INDICATIONS FOR ANTIRETROVIRAL THERAPY

Adults and teenagers

Clear indications for initiation of ART in patients with chronic HIV infection are the development of symptoms of immunodeficiency (AIDS), as well as the content of CD4-lymphocytes less than 0.2 x 10 9 /l (200/µl) in the presence or absence of an AIDS clinic. In asymptomatic patients, the need for ART depends on both the number of CD4 lymphocytes and the concentration of HIV RNA (). ART is also indicated for patients with acute HIV infection in the presence of severe clinical symptoms (mononucleosis-like syndrome, fever for more than 14 days, development of secondary diseases).

Table 1. Indications for ART initiation in adults and adolescents with chronic HIV infection

CHEMIOPROPHYLAXIS OF PARENTERAL HIV INFECTION

Methods for preventing parenteral HIV infection are used when medical workers are injured with an instrument contaminated with HIV. The effectiveness of these measures has not been fully studied. The probability of HIV infection without prophylaxis is quite low - when HIV-contaminated blood gets on the mucous membrane - 0.09%, and when injected with an instrument - 0.3%. The chemoprophylaxis scheme is chosen depending on the characteristics of the patient-source of HIV infection (). Chemoprophylaxis should be started as early as possible (preferably in the first minutes after a possible infection) and combined with local treatment. It is recommended to squeeze the blood out of the wound, treat the wound with an iodine solution, wash the mucous membranes on which the infected material has fallen (do not rub!) And treat them with antiseptic solutions (alcohol, boric acid, silver nitrate, etc.). If more than 72 hours have passed since the moment of possible infection, chemoprophylaxis is considered inappropriate.

Table 9. Choice of regimen for the prevention of parenteral HIV infection

Ritonavir, saquinavir, amprenavir, nevirapine are recommended to be used only after consultation with an expert.

* Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR, 2001.- Vol. 50: no. RR-11

Despite the progress of modern medicine in the treatment and prevention of HIV infection, according to WHO estimates, at the end of 2012 there were 35.3 million people with HIV in the world, of which 2.3 million were cases of new infections. In addition, more than 1 million people a year die from HIV-related complications (1). HIV is spreading most rapidly in Eastern Europe, and the incidence in Ukraine remains at a fairly high level. That is why the main goal of WHO is to optimize the prevention of transmission of this disease and existing methods of therapy, as well as to ensure timely monitoring of the effectiveness of therapy, minimizing side effects and thus increasing the overall effectiveness of treatment (1).

How does HIV work?

HIV infects immunocompetent cells - CD4 + T-lymphocytes, also called "helpers" (from the English word "help" - to help). It is this population of lymphocytes that carry CD4 receptors on the surface that is responsible at the cellular level for the immune response - the body's ability effectively resist infections.The virus gradually infects more and more CD4+-T-lymphocytes, and HIV-infected cells die.Accordingly, the number of CD4+-T-lymphocytes in the body decreases, which leads to a violation of first cellular immunity, and then the humoral immune response ( the production of antibodies that bind foreign agents when they enter the body).The virus then infects other types of cells, for example, macrophages, which are responsible for the "neutralization" of foreign agents that enter the body.As a result, the communication between different types of cells that underlies the immune system is disrupted. response.The damage to the immune system is growing, which leads to infection of the patient with concomitant HIV (the so-called. opportunistic) infections - tuberculosis, toxoplasmosis, hepatitis B and other dangerous diseases. At later stages, damage to the immune system leads to the development of malignant neoplasms and to acquired immunodeficiency syndrome (AIDS) - the last stage of the disease. Untreated, in most HIV-infected patients, it takes approximately 10-15 years from the time they are diagnosed with HIV to develop AIDS(3).

Can HIV be cured?

The main difficulty in fighting HIV lies in the strong variability of the proteins (proteins) that make up the virus envelope, due to which the immune system is unable to produce antibodies that can block the virus as it exits the cell and prevent its further spread and death of the T-lymphocyte population. Therefore, today there is no medicine that can completely cure the disease, although the achievements of modern medicine allow us to hope that the world is on the verge of discovering a method of therapy that will ensure the complete recovery of the patient. In 2013, a unique case of a 2.5-year-old girl was officially registered in the US state of Mississippi, who managed to recover immediately after an aggressive course of treatment carried out shortly after birth. And scientists at the University of Oregon were successful in animal studies of the HIV vaccine - if in phase 1 of the study the drug helped only 50% of infected monkeys, then in phase 2 almost 100% of animals completely got rid of the virus. This suggests that, in the future, it is possible to neutralize the virus at the stage when it is still in the cell.

However, today, when there is no cure for HIV, the key factor that determines the prognosis of the disease is the timely initiation of antiretroviral therapy, which can almost completely stop the progression of the disease and prevent further transmission of the virus (1).

What is Antiretroviral Therapy (ART)?

Antiretroviral drugs are aimed at slowing down the reproduction of the virus, i.e. to reduce its amount in the body. Antiretroviral therapy (ART) significantly slows down the progress of the disease precisely by preventing the replication of the virus and therefore reducing the concentration of viral RNA (known as "viral load" or "viremia") in the patient's blood. At the end of 2012, 9.7 million people were receiving antiretroviral therapy in low- and middle-income countries. According to the WHO recommendation, it is used only after all the necessary tests and the time of its start is determined by the individual attending physician (1). Indications for antiretroviral therapy and assessment of its effectiveness are based on the regular determination of the concentration of viral RNA (quantitative determination of HIV RNA) and the level of CD4 lymphocytes. A decrease in the concentration of viral RNA in the blood leads to an increase in the level of CD4 lymphocytes and a delay in the development of AIDS.

When should ART be started?

Regardless of disease stage, ART should be initiated in all patients with CD4 counts >350 cells/mm 3 and ≤ 500 cells/mm 3 . ART should also be started in all patients with a CD4 count of ≤350 cells/mm 3 in advanced and end-stage disease (WHO stage 3 and 4). If a patient has a co-infection, such as active TB or hepatitis B with chronic liver failure, ART is given regardless of CD4(2) count.

What drugs are prescribed as part of ART?

Highly active antiretroviral therapy, according to the 2013 WHO recommendations, consists of the simultaneous administration of three to four potent drugs. There are three groups of antiretroviral drugs: nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs)(2).

According to WHO recommendations, two NRTIs and one NNRTI (tenofovir (TDF) + lamivudine (3TC) or emtricitabine (FTC) + efavirenz (EFV) in fixed doses are prescribed as first-line ART for HIV infection; if this combination is not tolerated, zidovudine (AZT) + 3TC + EFV, or AZT + 3TC + nevirapine (NVP), or TDF + 3TC (or FTC) + NVP. The use of stavudine (d4T) as first-line therapy is not recommended because of its serious side effects Combination of two NRTIs and PI boosted with ritonavir is recommended as second-line therapy The general principles for switching to second-line therapy, as in the case of first-line therapy, are based on a combination of two NRTIs in fixed doses: if TDF regimen + 3TC (or FTC) has not been effective, a regimen based on zidovudine and lamivudine (AZT + 3TC) should be used, and if this regimen, or a regimen based on stavudine, when used as therapy, the first line proved to be ineffective, on the contrary, it should be replaced with the TDF + 3TC (or FTC) regimen. Of the protease inhibitors, atazanavir (ATV) and lopanavir (LPV) in fixed doses are recommended. Finally, WHO recommends that third-line regimens be regulated by national protocols, including drugs with a minimal risk of cross-resistance (resistance) of the virus to those drugs that have already been used in first- and second-line regimens in these patients, if for some reason these schemes had to be canceled (due to poor tolerability, inefficiency, severity of side effects).

The effectiveness of therapy is determined using clinical studies 6-12 months after its initiation. The most reliable is the determination of the level of RNA of the virus in the blood (viral load), but if this test is not available, the usual measurement of the level of CD4 lymphocytes is used, which can be used to judge the progress of the disease and the effectiveness of the applied regimen (2).

Why is ART adherence critical to a patient's prognosis?

According to various sources, up to 50% of HIV carriers refuse therapy after two to three years of treatment, thereby dooming themselves to the rapid progress of the disease and a deterioration in the quality of life (4). It is important to understand that HIV treatment is lifelong, which cannot be stopped - otherwise the resumption of the life cycle of the virus, which will "raise its head" shortly after stopping therapy, will lead to the beginning of a new round of death of immunocompetent cells, a deterioration in the state of immunity, the addition of new infections and the progress of the disease up to development of AIDS. In fact, HIV therapy does not require much change in the patient's usual regimen - ART drugs are usually taken once or twice a day, and patients who have the right regimen of therapy adjust their regimen very quickly. It is no different from the drug regimens taken by the “healthy” part of the population - people with diabetes, thyroid disease, cardiovascular disease, and sometimes it turns out to be much simpler - it is not for nothing that patients with a long history of taking ART often say that take these pills like vitamins.

Do not skip pills or “forget” the next dose more than 2 hours after the standard time of taking - statistics show that ART is effective when the patient takes at least 95% of the required dose of all drugs (4), which means that when once a day per month, you can skip just one dose, and when taken 2 times a day - no more than 3 doses!

In addition, it is necessary to be aware of possible drug interactions of ART components with other drugs taken by the patient. Sometimes the latter can increase the effect of ART, and sometimes, on the contrary, reduce it. The effect of drug interactions depends on the pharmacokinetics of the drugs additionally taken by the patient - the rate of reaching the maximum concentration in the blood, the half-life, absorption in the intestine. Therefore, you should not start taking any additional drugs on ART without consulting an infectious disease doctor. Even when taking painkillers or herbal remedies (phytotherapy), you should first consult a doctor. PIs and NRTIs are especially likely to interact with other drugs. Their effect may be reduced by drugs taken to reduce stomach acid (such as proton pump inhibitors) or certain antibiotics (macrolides). Conversely, regular grapefruit juice can multiply the effectiveness of some ITs many times over (4). There is also a "reverse" effect - drugs used for ART can reduce the effectiveness of, for example, some hormonal drugs, contraceptives - the latter are very quickly excreted from the body under the influence of ART - therefore, women taking ART are advised to use additional methods of contraception. Some strong opioid painkillers (methadone) also interact with ART medications and may require higher doses.

Separately, it should be noted drugs that reduce the level of cholesterol (Cholesterol) in the blood (statins), which some patients take constantly. Considering that one of the side effects of ART is an increase in the level of cholesterol, as well as other components of the so-called. “lipid profile” (for example, triglycerides (TG), it is logical to assume that on the background of ART, continued use of statins favors the patient’s overall health by lowering cholesterol levels. However, since both statins and ART drugs are metabolized in the body by the same way, their simultaneous the use of statins increases the dangerous side effect of muscle breakdown, or rhabdomyolysis, so it is imperative that you consult your doctor if you are taking statins and ART at the same time.

When taking ART drugs, one should not believe in the widespread myth that the constant use of HIV pills is harmful and associated with irreversible toxic effects. HIV therapy does have side effects, which, nevertheless, can be minimized, and often reduced to zero, if you follow the recommendations for treatment and undergo the necessary examinations so that the doctor can find out in time which organs and systems of the patient are most sensitive to the prescribed drugs, and stop the existing unwanted symptoms.

What are the side effects of ART?

Side effects of ART are divided into so-called. "early" and "late" (4). The "early" effects include diarrhea, nausea, vomiting, thirst, abdominal pain, fatigue, insomnia, hair loss, dyspepsia. Sometimes there may also be changes in the hematopoietic system, determined by the simplest studies, for example, a complete blood count (decrease in the number of neutrophils, or neutropenia) or biochemical studies (increased levels of ALT, AST (“liver tests”). It should be remembered that all these side effects the events can be short-lived, and also that their occurrence is associated not with ART in general, but with the intake of a certain drug of a certain group (NRTI, PI).

“Late” effects of ART include those adverse events that may occur after many months or years of taking the drug. The most serious of these include disorders of carbohydrate metabolism (increased blood sugar levels, up to the development of diabetes) and changes in lipid (fat) metabolism. These changes are very important to diagnose in time, because, unlike the "early" effects, they can go unnoticed by the patient, and, if untreated, increase the risk of cardiovascular disease, up to a heart attack.

Modern medicine has all the means to prevent the development of "late" side effects of ART. The most “noticeable” of these is lipodystrophy, or wasting of adipose tissue during ART, which is associated with lipid disorders and changes in the lipid profile of patients (5). Data from large studies show that the presence of lipodystrophy and an increase in CD4+ T-lymphocytes in patients with HIV is strongly correlated with an increased risk of cardiovascular events (heart attack) (5). In addition, lipodystrophy is very often associated with lipid metabolism disorders - an increase in cholesterol levels due to an increase in low-density lipoprotein (LDL) and TG levels. Especially often, an increase in the level of cholesterol and TG is observed in patients receiving PI therapy enhanced with ritonavir. Therefore, one of the main recommendations for patients receiving IP is regular monitoring of lipid metabolism (lipidogram). For 8-12 hours prior to this test, for which blood is taken from a fasting vein, the patient should not eat anything fatty, or better yet, not eat at all in order to get accurate results (4). The accuracy of lipid profile results in patients with HIV is of paramount importance, since it is important to diagnose lipid disorders at a stage before ART drugs have led to severe disorders. In the initial stages, lifestyle changes and a diet recommended to lower cholesterol (anti-atherosclerotic diet) and moderate exercise are often effective. However, if these measures are ineffective, the patient may be prescribed drugs that reduce the level of cholesterol and TG in the blood - statins. As already mentioned, some of them interact with the components of ART, so the appointment of a cardiologist should be agreed with the treating infectious disease specialist.

Finally, the undesirable late effect of ART medications, such as an increase in blood sugar levels, can be easily managed in the initial stages, while only fasting glucose is elevated, through diet and lifestyle changes. It is much more difficult to do this later, when carbohydrate metabolism disorders increase and reach even the development of a patient with type 2 diabetes.

That is why regular monitoring of carbohydrate (fasting blood sugar levels) and lipid (total cholesterol and triglyceride levels, and, if necessary, a more advanced study, the so-called lipid profile) is of paramount importance for patients receiving ART therapy (4) . In some regions (for example, on the African continent), such studies are recommended as routine screening for all patients with HIV infection, as an effective means of reducing the risk of CVD (6).

Can ART therapy improve the quality of life of patients?

Although ART therapy does not currently provide a complete cure for the patient, it can significantly increase life expectancy without compromising quality of life (4). It is very important in a timely manner, after confirming the diagnosis, to start one of the WHO-recommended treatment regimens and carefully adhere to it, informing the attending physician about all side effects, well-being during therapy, additionally taken drugs, and also undergo the prescribed examinations. Regular measurement of the level of viral load and/or CD4+ lymphocytes makes it possible to draw conclusions about the effectiveness of treatment, and regular monitoring of carbohydrate (blood sugar) and lipid (CS, TG) metabolism will help prevent unwanted side effects of ART therapy on the body in time. With the right selection of ART therapy, following the doctor's recommendations and regular follow-up examinations, it guarantees the patient a long and fulfilling life, which is in no way inferior to the life of a healthy patient in terms of quality.

Bibliography:

1. World Health Organization (WHO). HIV AIDS. Newsletter No. 360. October 2013.
2. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2013.
3. University of Washington Therapeutic Handbook. Moscow, 200, p. 388-404.
4. Elżbieta Bakowska, Dorota Rogowska-Szadkowska. LECZENIE ANTYRETROWIRUSOWE (ARV) . Materiały informacyjne dla osób żyjących z HIV. Krajowe Centrum ds.AIDS, Polska, 2007.
5. De Socio GV et al. CISAI study group. Identifying HIV patients with an unfavorable cardiovascular risk profile in the clinical practice: results from the SIMONE study. J Infect. 2008 Jul;57(1):33-40.
6. Ssinabulya I et al. Subclinical atherosclerosis among HIV-infected adults attending HIV/AIDS care at two large ambulatory HIV clinics in Uganda. PLOS One. 2014 Feb 28;9(2)

Basic principles HAART

Effectiveness of antiviral chemotherapy HIV-infection directly depends on the observance of several important conditions. These include:

Early initiation of therapy. It is very important to start treatment before the level CD4-lymphocytes will drop below 200 per µl. This significantly improves the prognosis of the course of the disease.

Simultaneous use of 3 drugs from 2 different classes. With a lower load, the effectiveness of treatment decreases, and the virus adapts to drugs faster.

Adherence to treatment - the desire of the patient to contribute to his recovery, regular medication and medical supervision. This simple component of success in life is the most difficult. up to half HIV-infected in Russia - intravenous drug addicts. Most of this category of people do not have high adherence to treatment, not only dooming themselves, but also contributing to the growth of the epidemic.

Compliance with the basic principles of treatment directly affects how and how long people with HIV infection live.

Disadvantages of existing treatments

The need for periodic replacement of antiretroviral drugs due to the development of resistance of the virus to treatment, toxic effects on the body and the need to treat concomitant diseases. Scheme HAART significantly reduce the risk that virus mutations will make it resistant to treatment, but such a scenario is not completely excluded.

Needless to say, what to use pills from HIV need for life and regularly. Moreover, the prescribed drugs must be taken not just daily, but also at the strictly appointed time. A delay in taking the drug or taking it in an incomplete dose leads to a decrease in its antiviral efficacy, and an earlier intake enhances the toxic effect of the drug. Having missed a dose, you can not take an increased dose of the drug - this creates an excessive drug load on the body, but does not affect the antiviral activity.

All of the above does HAART rather painstaking procedure and reduces adherence to treatment, however, there is no other alternative in our time. How else to treat HIV-Infection, unfortunately, has not yet been invented. However, combined preparations are already actively used, which contain all the components necessary for treatment, but some of them are not registered in the territory. RF, and the rest are not always available due to their high cost.

How antiretroviral therapy works and possible treatment regimens

The first antiretnoviral drug to be approved for use by healthcare professionals HIV-infection, became zidovudine. It began to be actively used in 1987. However, therapy with one drug did not show sufficient effectiveness, and work on the creation of new drugs for HIV continued and continues to the present.

Classes ARV drugs

• cirrhosis of the liver during treatment with nevirapine;
• toxic epidermal necrolysis - nevirapine, efavirenz;
• lactic acidosis - Stavudine + Didanosine, less often others;
• inflammation of the pancreas - Zidovudine;
• kidney damage - Tenofovir.

There are many other side effects that all antiretroviral drugs are involved in one way or another.

The start of treatment may be delayed in active tuberculosis, severe liver and kidney damage, and other conditions that require stabilization of vital signs.

Exemplary regimens of therapy

Today, work is underway, the purpose of which is to find such a drug, but so far they cannot give unambiguous conclusions. It is believed that the increase in the number CD4 cells provides new targets for the virus, but this statement is speculative, as well as the fact that such growth occurs at all under the influence of immunomodulators.

The only proven way to boost immunity when HIV in our time, it is to reduce the viral load, and only antiretroviral therapy can cope with this.

Where and how are they treated? HIV an infection?

According to domestic standards HIV-Infection does not always require treatment at all. While immunity is at a high level, according to domestic guidelines, the patient only needs periodic monitoring.

Is there a cure for HIV, which would not have a toxic effect on the body?

All antiretroviral drugs are toxic to some extent, but new generation drugs are much easier for patients to tolerate.

Often the toxic properties of these drugs are exaggerated. Indeed, when a person starts taking antiretroviral drugs, he often feels very ill, but this is not always the result of side effects of drugs.

Clinical trials of a therapeutic vaccine against HIV, which has previously shown, albeit insufficient, but effective. Might be a problem soon. HIV will remain in history. In the meantime, it remains to strictly adhere to the scheme HAART which, although not always convenient to use, save the lives of millions of people around the world.

HIV today is not a sentence. Patients can live peacefully with this disease, work, start a family. All that needs to be done is to be regularly treated with antiretroviral chemotherapy drugs. All these drugs are divided into three classes: HIV protease inhibitors, nucleoside and non-nucleoside HIV reverse transcriptase inhibitors.

It is worth remembering that antiretroviral drugs cannot completely cure AIDS. There is also no way to protect yourself from infection. Medicines only interfere with the improvement of the patient's condition. The most popular antiretroviral drugs will be described below.

"lamivudine"

The agent belongs to the group of nucleoside inhibitors of HIV reverse transcriptase. The antiviral agent penetrates the cells and is metabolized there, thereby causing inhibition of viral replication. The method of therapy for HIV infection using the drug "Lamivudine" shows high efficiency. The agent is also active against the hepatitis B virus. The drug is quickly absorbed from the gastrointestinal tract. Within an hour after taking the drug, plasma bioavailability reaches 80%. Communication with plasma proteins is 30%. It should be borne in mind that the active ingredient easily penetrates the placental barrier.

Lamivudine is used to treat HIV in adults and children. Most often, the drug is used as part of complex therapy (other antiviral agents are additionally used to treat HIV). Also, the medication can be prescribed for chronic viral hepatitis B. The drug is not contraindicated during pregnancy and lactation. The tool can be used for the treatment of infants. It is worth stopping the use of drugs only if there is an increased sensitivity to the components.

drug interaction

Joint reception of funds "Lamivudin" and "Zimavudin" is possible. In this case, it should be taken into account that the bioavailability of drugs will significantly decrease. It is not recommended to simultaneously use drugs that have didanosine or sulfanilamine in their composition. Neglect of this recommendation can lead to exacerbation of pancreatitis. Significantly increases the concentration of the active substance - lamivudine - in the blood of the drug "Trimethoprim".

Therapy is carried out only as directed by a doctor. It will not be possible to buy Lamivudine at a pharmacy without a prescription. The price of the medicine is 3500 rubles. The dosage and treatment regimen is set by a specialist, based on the individual characteristics of the patient's body, as well as the form of the disease.

The drug should be used with caution in violation of kidney function. The drug can be prescribed by a specialist in the minimum dosage if the CC is less than 50 ml / min. When developing a treatment regimen, the doctor must take into account that the active ingredient is excreted mainly by the kidneys. People with impaired liver function do not require dosage adjustment. With the appearance of such alarming symptoms as abdominal pain, nausea, vomiting, the drug "Lamivudine" should be canceled. The specialist examines the patient. Therapy can be resumed only when the diagnosis of "acute pancreatitis" is excluded.

An effective tool in the treatment of HIV infection is Lamivudine. The price of the drug is relatively low. It is worth remembering that no medicines can protect against infection through blood or sexual contact. The medicine cannot be used as a prophylaxis.

"Didanosine"

It has a high activity against HIV. Specialists quite often use the tool "Didanosine". The instruction describes the method of application, indications and dosage. The drug is available in the form of tablets, chewable tablets, capsules. They can also be used to prepare a suspension. The active ingredient is didanosine. Additionally, substances such as aspartame, magnesium hydroxide, sorbitol, calcium carbonate, magnesium stearate and tangerine flavor are used. The tool is available in dosages of 100, 125, 200 and 400 mg.

Didanosine is a synthetic analogue of the nucleoside dioxyadenosine that inhibits the HIV response in the cells of the body. The bioavailability of the active ingredient reaches 60% an hour after taking the medicine inside. The drug will be more effective if it is used one hour before a meal or 2 hours after a meal. Use together with food products leads to a decrease in the bioavailability of the active ingredient by 50%. The drug is excreted by the liver and kidneys. The metabolism of didanosine directly depends on the degree of impaired renal function.

The drug can only be used in combination with other antiviral drugs for the treatment of HIV infection. The drug is allowed to be prescribed to women during the period of gestation and lactation. The remedy "Didanosine" is not contraindicated for children. The drug is not prescribed only for babies under three years of age. It is necessary to cancel the medication if there is an increased sensitivity to the main component. People with impaired liver function should use the drug with caution.

How to take medicine?

The dosage is set by the doctor depending on the severity of the disease, as well as the individual characteristics of the patient's body. Antiretroviral therapy can be carried out according to the recommendations specified in the instructions. The daily rate depends on body weight. People weighing less than 60 kg should take no more than 250 mg per day. For patients weighing more than 60 kg, the dosage can reach 400 mg. Capsules are taken once a day. They cannot be chewed. You should drink plenty of water. It is recommended to carry out therapy in the morning, on an empty stomach.

Tablets can also be used to prepare a suspension. All you need to do is dilute the product with a little boiled water. The entire daily rate can be divided into two doses. The prepared suspension cannot be stored for more than an hour. In the evening, the remedy should be taken at bedtime, 2 hours after eating. For children under 5 years of age, the medicine is prescribed only in the form of a suspension.

Patients over 70 years of age undergo dose adjustment. This is due to the fact that in old age, kidney function is impaired. The standard daily allowance can lead to the development of side effects such as pancreatitis, peripheral neuropathy, lactic acidosis. On the part of the gastrointestinal tract, such unpleasant phenomena as dry mouth, anorexia, nausea, and vomiting can develop. In case of deterioration of health, the patient is recommended to consult a specialist. Perhaps the drug will be discontinued. The doctor will prescribe a quality substitute ("Thymidine" or analogues of "Thymidine", "Abacavir", "Lamivudine").

Videx

The active ingredient in this medicine is also didanosine. Antiretroviral drugs from this group are widely used in the treatment of HIV infection. The positive is the fact that the medicine can also be used for infants. For young patients, Videx is prescribed in the form of a powder for the preparation of a suspension. The dosage is calculated individually in accordance with the degree of infection, as well as the individual characteristics of the patient's body. The drug is not used only if hypersensitivity to didanosine develops.

Antiretroviral therapy is given as soon as an infection is detected. As a prophylaxis, the drug is not used. The drug has practically no contraindications. Videx tablets or powder do not cause the development of side effects if the dosage regimen is correctly selected. The drug should be discontinued if there is a suspicion of the development of pancreatitis.

Zidovudine

The antiviral drug has a high activity against HIV. The active ingredient is zidovudine. Instructions for use also describe excipients. These include pregelatinized starch, microcrystalline cellulose. The film shell consists of titanium dioxide, polydextrose, glyceryl caprylocaprate. The drug is used as part of a combination therapy for HIV-1 infection. During pregnancy, the drug can be used as a prevention of perinatal transmission of the virus from mother to fetus.

The medicine has a number of contraindications. Zidovudine tablets are not prescribed for children, as well as adult patients whose weight does not exceed 30 kg. In rare cases, hypersensitivity to the active ingredient may develop. The drugs are taken orally, regardless of the meal. Those who have purchased Zidovudine 300 must use two tablets per day. If the patient's weight exceeds 60 kg, you will have to take 20 mg of the drug twice a day.

Belongs to the group of expensive drugs "Zidovudine". The price of one package of 60 tablets exceeds 10,000 rubles.

"Abacavir"

The active ingredient in the tablets is abacavir sulfate. The drug is widely used in antiviral therapy for HIV. Additionally, the composition of the tablets includes the following components: microcrystalline cellulose, yellow iron oxide, polysorbate, titanium dioxide, magnesium stearate, yellow opadry, triacetin. The drug can only be used as part of combination therapy. Tablets "Abacavir" are not prescribed for hypersensitivity to the main component. The drug is contraindicated in small patients whose body weight does not exceed 14 kg. Caution should be exercised in patients with renal insufficiency.

The dosage of the drug is calculated individually in accordance with the form of infection of the patient. For adults, the average daily allowance is 600 mg per day (divided into three doses). The use of tablets in an increased dosage can lead to the development of an allergic reaction.

Also referred to as an expensive tool "Abacavir". The price of one pack of tablets can exceed 15,000 rubles.

"Ziagen"

The active ingredient, as in the previous case, is abacavir sulfate. The drugs are analogues and may well replace each other. Means "Ziagen" is effectively used in the complex therapy of HIV infection. The medicine allows you to improve the patient's condition, return to a full life. Tablets have practically no contraindications. The drug is not prescribed only to patients whose weight does not exceed 14 kg.

The daily rate of the drug is determined by the doctor. The form of the disease is taken into account, as well as the individual characteristics of the patient (weight, age). Children whose weight does not exceed 20 kg are prescribed half a tablet twice a day. The daily rate for an adult patient can reach three tablets per day.

Improper use of the drug can lead to the development of side effects. It is worth seeking help from a doctor if symptoms such as diarrhea, abdominal pain, nausea, and vomiting develop. These phenomena may indicate pancreatitis. Allergic reactions in the form of rash and itching are also often observed.

Ziagen tablets may well replace Zidovudine. The price of drugs is practically the same.

"Olithid"

The antiviral drug has activity against HIV infection. The active ingredient is abacavir sulfate. The drug is available in the form of a powder for the preparation of a suspension, as well as tablets. Means "Olitid" can only be part of complex therapy. The drug is not used on its own. The dosage of the drug is determined by the doctor. The uniform can only be used for patients whose weight exceeds 14 kg. With caution, tablets "Olitid" are prescribed in old age. This is due to the risk of impaired renal function.

Antiretroviral drugs, including the medicine "Olitid", are used strictly according to the prescription of a specialist. It is not possible to buy medicines in a pharmacy without a prescription.

"Retrovir"

The drug is widely used as part of the complex therapy of HIV. After oral administration, the drug is rapidly absorbed from the gastrointestinal tract. The active ingredient easily penetrates through. This is taken into account when developing a treatment regimen for pregnant women. The medication can be used as a prophylaxis for occupational HIV infection. This is especially important for laboratory workers who conduct research on contaminated materials.

The dosage of the drug is set individually by the attending physician. The maximum daily allowance for adults cannot exceed 600 mg. Experts recommend dividing it into three doses. It will be more effective if taken on an empty stomach. If you experience any side effects, you should consult your doctor.