In the early 1980s when the HIV/AIDS epidemic began, people with AIDS were not likely to live longer than a few years.
Today, there are 31 antiretroviral drugs (ARVs) approved by the Food and Drug Administration to treat HIV infection. These treatments do not cure people of HIV or AIDS. Rather, they suppress the virus, even to undetectable levels, but they do not completely eliminate HIV from the body. By suppressing the amount of virus in the body, people infected with HIV can now lead longer and healthier lives. However, they can still transmit the virus and must continuously take antiretroviral drugs in order to maintain their health quality.
NIAID’s HIV/AIDS Treatment Research
NIAID is focused on finding new and more effective therapies, drug classes, and antiretroviral drug combinations that can extend and improve the quality of life for people living with HIV/AIDS. NIAID supports research that advances our understanding of HIV and how it causes disease, thereby unlocking new targets for drug development. Promising medicines are then tested in human clinical trials to determine whether they are safe and effective. This process usually takes several years to complete before a new therapy is available to the public.
Classes of HIV/AIDS Antiretroviral Drugs
The antiretroviral medications used to treat HIV/AIDS currently are organized into five major drug classes:
Reverse Transcriptase (RT) Inhibitors interfere with the critical step during the HIV life cycle known as reverse transcription. During this step, the HIV enzyme RT converts HIV RNA to HIV DNA. There are two main types of RT inhibitors:
- Nucleoside/nucleotide RT inhibitors are faulty DNA building blocks. When these faulty pieces are incorporated into the HIV DNA (during the process when HIV RNA is converted to HIV DNA), the DNA chain cannot be completed, thereby blocking HIV from replicating in a cell.
- Non-nucleoside RT inhibitors bind to RT, interfering with its ability to convert the HIV RNA into HIV DNA.
Protease Inhibitors interfere with the protease enzyme that HIV uses to produce infectious viral particles.
Fusion/Entry Inhibitors interfere with the virus' ability to fuse with the cellular membrane, thereby blocking entry into the host cell.
Integrase Inhibitors block integrase, the enzyme HIV uses to integrate genetic material of the virus into its target host cell.
Multidrug Combination Products combine drugs from more than one class into a single product. To combat virus strains from becoming resistant to specific antiretroviral drugs, healthcare providers recommend that people infected with HIV take a combination of antiretroviral drugs known as highly active antiretroviral therapy (HAART). Developed by NIAID-supported researchers, the HAART strategy combines drugs from at least two different antiretroviral drug classes.
Another HIV/AIDS drug class known as maturation inhibitors is still in development, but if successful, could potentially prevent HIV from properly assembling and maturing. For example, these treatments could block HIV from forming a protective outer coat or from emerging from human cells.
Adherence and Drug Resistance
People infected with HIV who take antiretroviral treatments sometimes find it difficult to adhere to their drug regimens. This can be caused by the complexity of having to take several drugs each day or the unpleasant side effects that may result from some medicines, such as nausea and vomiting. However, when patients fail to take their medicines, HIV has an opportunity to create more variations of itself, including strains that are resistant to antiretroviral drugs. Therefore, it is important for people to continue taking their medicin...
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