HIV Treatments, a story that never ends
HIV has been one of the greatest medical challenges in recent history. Ever since the first cases appeared, the scientific community has searched for a way to stop it and, finally, defeat it.
Up until now, the best tools that we have to prevent it from causing health hazards are antiretroviral medications. The reason for their name is that HIV is a type of virus called a retrovirus (which has RNA as genetic material that turns into DNA when infecting the cell).
But antiretrovirals (or ARV, for short) are not the same as they were in the beginning. Scientific research has allowed for treatments to become increasingly easier to take and with less side effects, in order to make it easier for people to properly adhere to treatment.
How do ARVs act?
“ARVs are medications which prevent HIV from reproducing in vast amounts once it has entered our body,” Dr. Rubén Vásquez from AHF Peru explains. “This way we stop the virus from having an effect on the body’s defenses, on these defense cells known as CD4”.As a specialized infectologist, Dr. Vásquez describes the way in which HIV attacks the cells:
ARVs act by blocking one of the virus’ several reproductive cycle steps. For instance, medications which prevent the virus membrane and the cell to fuse are called fusion inhibitors; the ones that keep the virus’ RNA from transforming into DNA are reverse transcriptase (enzyme) inhibitors, and those which prevent the virus from reaching the cells nucleus are called integrase (enzyme) inhibitors, just to mention a few.
For the HIV treatment to work properly, several of these medications must be used in order to inhibit the virus’ reproduction in different stages in its cycle. “In each cycle, what we may call ‘offspring virus’ are formed, millions of them in each cycle, these viruses then leave the cell and infect new cells, and thus, the spread of the infection becomes exponential”, since each cell infected by the virus becomes in itself, “a virus factory”.
However the challenge is not only the amount of HIV in the organism (which is usually measured in copies of the virus per milliliter of blood, or copies/ml) but rather that “sometimes these viruses are not identical to the original, they vary a little”, Dr. Vásquez states. “That is why somehow the virus cannot be eliminated, it cannot be killed, because many of these ‘offspring viruses’ are not identical to the original virus, the ‘mother virus’”.
Ever since the first treatments, created in the 80’s and 90’s, there has been an important evolution, the specialist argues. “One of the most important milestones, I would say, is looking for less toxic medications”. We have to remember that all medications have adverse effects, but in the case of ARVs their percentage was higher at the beginning.
The first ARV approved to treat HIV was zidovudine, commonly known as AZT. “Zidovudine has saved many lives, we need to make that clear, but afterwards, medications appeared which had less adverse effects”. The medication that replaced zidovudine was stavudine and then came tenofovir, which until this day is still being used as part of the treatment plans.
The Dr. states that between 2006 and 2007 medications with less side effects were created, that were better tolerated and even coformulated medications appeared, which was another milestone in treating the virus. “Before, the patient needed to take 2 or 3 medications in the morning, afternoon and evening, they would need to take between 6 to 8 pills every 8 hours, and there was definitely a question on whether they would be able to tolerate the medication. Once coformulated medications showed up, it was just one dose of a single tablet, this was an important achievement, it allowed for people to better adhere to treatment”.
But still, there were some important side effects. “For example, there is a medication that is not widely used in the United States and Europe anymore, however it’s still a first choice medication in Latin America; efavirenz, which is part of a widely used coformulate, however, it had very uncomfortable side effects for people, such as dizziness, drowsiness or insomnia and restlessness”.
In 2012 a new group of ARVs, also called integrase inhibitors were created, which are actually part of worldwide treatment plans and with much less side effects, these are also administered in one dose of a single tablet, they are much better tolerated and even have less interactions with other medications. “Because the other issue that we observe in Latin America is that we have a lot of tuberculosis and the effectiveness of medications to treat tuberculosis can be affected when taken together with efavirenz or protease inhibitors”.
To this day, a cure for HIV has not been found, which means that people who have the virus must take the medication permanently. Also, it’s very important that the treatment be taken diligently in order to avoid complications like the ones the Dr. explains. .
Some people may, for several reasons, suspend the treatment or not take it regularly, but “this can lead to the virus becoming resistant, because, once the medication reaches a certain concentration in the body, it puts a cap on the virus’ reproduction. However, the virus’ reproduction is imperfect, there are mutated versions of the virus which make it difficult to control”. When the medications are stopped, “that cap is broken and more of the virus shows up”, which in turn, will be resistant to the treatment that was being used.
Viral resistance will make it necessary to change the ARV treatment and, we have to point out that “the new medication will likely no longer be a single dose one, more doses will have to be taken, there will be more interactions, some new side effects, so it’s important to clearly explain to the patient that treatment must be taken every single day”.
Knowing the past, looking towards the future
According to Dr. Vásquez, this important evolution of ARV treatment has facilitated its adherence and has improved its effectiveness, however, the research path is not over yet.
In 2019 and 2020 new medications were developed which are applied by intramuscular injection every two months, which “is also an important evolution which will facilitate treatment to those people who can’t tolerate taking medication every single day”.
Medical research keeps advancing, “not with as much intensity as in the beginning of the epidemic, however there are some interesting developments”.
But while a definitive success is achieved against the infection, it’s important to continue spreading prevention and self care messages, especially to the young population that did not witness the crisis unleashed by aids in the 80’s. HIV must not be cause for stigma or discrimination, but it must not be underestimated either, since receiving a diagnosis such as this can alter several aspects of life. Because of this, Dr. Vásquez considers that prevention messages must continue to be communicated which have to be clear and straightforward, so that people may assimilate them properly.
If you haven’t had an HIV test or you need condoms for protection, at AHF Latin America and The Caribbean we offer both for free. Contact us in the nearest office in your country or write to us via Whatsapp.