HIV Theraphy

Current HIV therapy available in selected government health clinics and hospitals in Malaysia is highly active antiretroviral therapy (HAART). HAART therapy consists of at least three antiretroviral (ARV) drugs to suppress the HIV virus and to stop the disease progression.

All patients with HIV are recommended to take antiretroviral treatment regardless of CD4 counts. The treatment will prolonged and improved the quality of life of the patients. Patients have to adhere strictly to the treatment schedule. Patients will be given the first line os HAART. If the virus becomes resistant of the side effect is intolerable, secondline treatment is recommended.

Anti retroviral drugs is listed below. These drugs are classified according to the  different ways of action they attack the HIV virus.

  1. Nucleoside reverse transcriptase inhibitors(NRTI)/ Nucleoside reverse transcriptase inhibitors (n+RTI)
    1. Zidovudine (AZT)
    2. didanosine buffered or enteric coated (DDI)
    3. stavudine (D4T)
    4. Lamivudine (3TC)
    5. abacavir (ABC)
    6. tenofovir (TDF)
    7. Emtricitabine (FTC)
  2. Non nucleoside reverse trancriptase inhibitor (NNRTI)
    1. Nevirapine (NVP)
    2. Efavirenz (EFV)
    3. Etravirine (ETV)
  3. Protease Inhibitor (PI)
    1. Lopinavir/ritonavir (LPV/r)
    2. Saquinavir (SQV)
    3. Atazanavir (ATV)
    4. Darunavir (DRV)
    5. Ritonavir (RTV)
  4. Integrase inhibitors
    1. Raltegravir
  5. CCR5 Antagonist
    1. Maraviroc
  6. Fusion inhibitor
    1. Enfuvirtide

What is the importance of good compliance to HIV therapy

Before starting the first line HIV therapy, you need to agree and commit to lifelong therapy. The doctor or pharmacist will explain the benefits and risks of therapy and you need to understand the importance of adherence. You may choose to postpone therapy, and doctors, after discussing with you, on a case-by-case basis, may elect to defer therapy based on your well being and other psychosocial factors.

This is because HAART combination requires you to take the pills at similar time of the day every day. In the initial phase of treatment you may need to visit your doctor regularly. If you frequently miss the pills, it may not cause desirable viral suppression. If this occurs, the virus becomes resistant to your medications and cause treatment failure. Once the treatment fails, the next step is to use second line drugs which are more expensive and have more side effects.

How to help patient to comply to the HIV therapy

Once you agreed for starting the HIV therapy, the doctor will counsel on how to take the pills, how to fit in the pills into your daily routines. They should also provide dosing schedule and reinforce the importance of adherence. You are advised to seek help from your friend or family member to remind you on taking the pills. Apart from that, doctors or staffs should provide contact numbers to assist you if any problem arises.

Side effect of HIV therapy

HIV medication can cause side effects. It may cause you to stop the pills and cause poor compliance to the pills. If this happens, you should see your treating doctor immediately.

The possible side effect is listed in the table below.

ARV

Side effect

Zidovudine (AZT) Anaemia / Neutropenia
Gastrointestinal intolerance
Stavudine (D4T) Lactic acidosis
Lipoatrophy/metabolic syndrome
Peripheral neuropathy
Tenofovir (TDF) Renal toxicity
Efavirenz Central nervous system toxicity
Hallucination and psychosis
Nevirapine Hepatitis
Hypersensitivity reaction Stevens- Johnson syndrome

When treatment for HIV should be started in adults?

  • All HIV patients be started with antoretroviral treatment regardless CD4 level
Last Reviewed : 28 August 2020
Writer : Dr. Hasniza bt. Hasim
Reviewer : Dr. Nor Faizah bt. Ghazali