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Combination Therapy for HIV/AIDSUnderstanding the Need for a 'Cocktail' of ARV Drugs
For an HIV/AIDS medical regimen to be effective, a combination of two or more antiretroviral drugs is usually necessary to reduce drug resistance.
When the Human Immunodeficiency Virus (HIV) replicates, it does not make perfect copies of itself but rather, creates new strains in the process. This means that an HIV+ person actually has many different strains of the virus inside his/her system. New strains of HIV which are resistant to the effects of a particular antiretroviral (ARV) drug may appear. These will then replicate quickly and wipe out the benefits of any on-going treatment regimen based on that drug. For a treatment regimen to be effective over the long term, it has to include more than one ARV drug at a time. Taking two or more ARV drugs concurrently, known as combination therapy, can vastly reduce the rate at which drug resistance develops. HAARTThe term Highly Active Antiretroviral Therapy/Treatment (HAART) refers to the use of a combination of three or more ARV drugs in a daily regimen. This is also referred to as a ‘cocktail’, and is needed to ensure that the decrease in viral load is sustained. The ‘foundation’ of HAART is the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI) group. Most treatment regimens contain at least two NRTI drugs. The most common combination given to those just starting treatment for HIV/AIDS consists of two NRTIs (e.g. zidovudine and lamivudine) combined with either:
However, there is no such thing as an ‘ideal’ combination. The actual number of pills to take and the frequency of dosage will depend on the types of ARV drugs prescribed by the doctor. The doctor has to regularly monitor the effectiveness of the drugs through testing for the patient’s CD4 cell count and the viral load in his/her body. The patient must also provide feedback to the doctor on his/her reaction to the drugs, including side-effects and their severity. Changes in Treatment RegimeOver time, as the virus replicates into new strains, other drugs will have to be introduced to ensure that the treatment remains effective. Newer forms of therapy arising out of research and clinical trials may also be introduced as part of the treatment. As such, the treatment regimen for HIV/AIDS is actually very personal (varies between individual patients), as well as highly dynamic (changes over time for the same patient). New forms of treatment include pills that contain a combination of two or even three different ARV medications. Examples of two-in-one drugs include Truvada and Epzicom, which needs to be taken only once a day. Atripla goes one step further by combining three drugs, thus providing a complete HAART regimen by taking a pill daily. Thus, the concept of taking a 'cocktail' of drugs may eventually be replaced. Food for ThoughtEven though ARV drugs are getting more powerful in inhibiting the effects of HIV, and HAART regimens are getting simpler and more convenient, one must remember that these do not cure HIV infection and AIDS. Individuals who are on HAART can still transmit the virus to other people. Do also note that once HAART has begun, it must always be adhered to for the rest of the patient’s life. In addition, there are cases whereby all ARV drugs seem to stop being effective after a number of years. Since there is still no cure for HIV/AIDS at the moment, the best way is to practise safer sex to prevent being infected by HIV.
The copyright of the article Combination Therapy for HIV/AIDS in Chronic Illness Treatments is owned by Kris Lee Wai Loon. Permission to republish Combination Therapy for HIV/AIDS in print or online must be granted by the author in writing.
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