by Sudesh Samuel

Created on: January 12, 2009

A variety of medications is now available to combat the Human Immunodeficiency Virus (HIV) that causes Acquired Immuno-Deficiency Syndrome (AIDS) yet no single medicine to-date is effective when taken alone and none of them provide a cure. Combinations of HIV medications are valuable in controlling the amount of virus in the body as well as maintaining the health of the body's immune system.

The medications that are currently available come in 5 different classes and each works in a different way and oftentimes at different stages of the condition to limit HIV from multiplying. These core classes are Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Protease Inhibitors (PIs), entry inhibitors and integrase inhibitors.

NRTIs work to provide defective raw material to HIV as it tries to build replication systems in body cells. An example is Emtriva (emtricitabine). NNRTIs work to provide incorrect blueprints for HIV as it tries to order the replication process. An example is Sustiva (efavirenz). PIs work to provide defective parts to each new HIV as it is assembled. An example is Reyataz (atazanavir). Entry inhibitors work to prevent HIV from entering body cells. An example is Fuzeon (enfuvirtide). Integrase inhibitors work to prevent HIV that has already entered body cells from inserting code into body cell DNA. An example is Isentress (raltegravir).

Different combinations of medication from these classes make up the treatment regime known as Highly Active Anti-Retroviral Therapy (HAART).

No single combination of medications in HAART has proven to be best for everyone and treatment benefit is often optimized from selecting a suitable combination after having compared the advantages and disadvantages of the medications within the classes involved. The most common class combinations prescribed at the beginning of HIV treatment are either an NNRTI in combination with two NRTIs or the combination of a PPI with two NRTIs. PPIs can act as boosters, increasing the power of the other medications in the treatment regime.

The choice of HAART regimen should be discussed in detail with the prescribing doctor and often hinges on several key issues that include how powerful the initial combination is, whether there is preservation of other future combinations should there be resistance to the initially chosen one, what side effects are likely to occur, how many pills need to be taken and how often these pills

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