HIV Theraphy

Current HIV therapy available in selected government health clinics and most 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.

Not all patients will require the treatment in the early HIV disease. The managing doctor will have to check your current health status along with CD4 T cell count in your body and then decide the need for treatment.

Usually treatment is indicated in patients with:

  1. Clinical signs of AIDs disease
  2. Symptomatic HIV infection regardless of CD4 count
  3. Asymptomatic HIV with CD4 count <350 cells/mL
  4. Asymptomatic HIV with CD4 count >350 cell/mL but with CD % <14%

If you fulfilled one of the above criterias , you will be started with first line Highly Active Antiretroviral Therapy (HAART) combination. If the virus becomes  resistant to this combination or the side effects is intolerable, second line therapy is recommended.

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

  1. Nucleosidase reverse transcriptase inhibitors(NRTI) / Nucleosidase reverse transcriptase inhibitors (n+TRI)
    1. Zidovudine (AZT)
    2. didanosine buffered (dd) or enteric coated 9ddI EC)
    3. stavudine (d4T)
    4. Lamivudine (3TC)
    5. abacavir (ABC)
    6. tenofovir (TDF)
    7. Emtricitabine (FTC)
  2. Non nucleoside reverse trancriptase inhibitor (NNTRI)
    1. Nevirapine
    2. Efavirens
    3. Etravirine
  3. Protease Inhibitor
    1. Indinavir (IDV)
    2. Lopinavir/ritonavir (Kaletra)
    3. Saquinavir
    4. Atazanavir (ATV)
    5. Darunavir (Prezista)
    6. Ritonavir
    7. Nelfi navir (Viracept)
  4. Integrase inhibitors
    1. Raltegravir (Isentress)
  5. CCR5 Antagonists
    1. Maraviroc (Celsentri)
  6. Fusion inhibitor
    1. Enfuritide (Fuzeon)

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
Efavirens Central nervous system toxicity
Hallucination and psychosis
Nevirapine Hepatitis
Hypersensitivity reaction Stevens- Johnson syndrome

When treatment for HIV should be started in adults?

  • When CD4 count < 300 cells/mm3

For HIV patients who have a CD4 count > 350 but < 500 cells/mm3
Treatment may be considered for those who are:

  • In a sexual relationship with HIV negative person
  • Highly motivated to comply with treatment
  • Pregnant or breastfeeding
  • Coinfected with Hep B
  • Homosexual who cannot adhere of using condom
  •  Active TB disease
Table 1 : Antiretroviral drugs that are registered in Malaysia

 

Last Reviewed : 28 August 2015
Writer : Dr. Hasniza bt. Hasim