Latest advancements in HIV treatment.

HIV, a disease as old as time has been studied and is still being studied to find long-lasting treatment options and potential cure. Over the years scientists have come up with different drugs that help to reduce the viral load in affected people to increase their chances of having a healthy normal life and reduce the incidence of spread from one person to another.

HIV affects over 38 million people worldwide and the stigma associated with this disease is still prominent. Although people are more aware these days , it still does not change the fact that people are still less accepting of infected people in the society.

HAART

In recent times, HIV is being treated with Highly active antiretroviral therapy (HAART) which is a combination of at least two to three different classes of drugs in this therapy regimen. There are currently 7 classes of antiretroviral drugs used in the management of HIV. They include:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Protease inhibitors (PIs)
  • Fusion inhibitors.
  • CCR5 antagonists.
  • Integrase strand transfer inhibitors (INSTIs)
  • Entry inhibitors

The common regimen is usually a combination of 2 drugs from the NRTIs and one drug from PI/ NNRTIs. These drugs are usually required to be taken either once or twice a day. This can be very difficult for people to comply with as it might be difficult to remember to take this pills everyday due to a busy schedule. It also increases risk of developing resistance due to consistent exposure of the virus to the drugs.

What’s new?

In 2021, FDA approved the use of a new drug called Cabenuva which consists of two drugs Cabotegravir and rilpivirine. Cabotegravir is an integrase inhibitor while rilpivirine is a Non-nucleoside reverse transcriptase inhibitors (NNRTIs). The regimen include Cabenuva: Cabotegravir 400 mg IM + rilpivirine 600 mg IM once monthly; initiate after 1 month of lead-in therapy with cabotegravir 30 mg + rilpivirine 25 mg PO qd. In this new regimen, the drug is taken once monthly as opposed to being taken everyday.

Another drug approved by the FDA in 2022 called Lenacapavir. It belongs to a new group called capsid inhibitors. It works by binding to the HIV capsid is a protein shell that protects HIV’s genetic material and enzymes needed for replication. Capsid binding interferes with multiple essential steps of the viral lifecycle. This drug is just taken twice a year. Lenacapavir (Sunlenca) is indicated for heavily treated adults with multi-drug resistant HIV-1 infection in addition to an optimized drug regimen.

A US company called ViiV healthcare is working on an HIV cure. The main challenge is that HIV can hide itself and lay dormant in pockets of host cells that are unrecognised as harbouring HIV by the immune system. Even if an individual has successfully suppressed their HIV through ARV treatment, the hidden HIV, called the “latent reservoir,” can re-emerge if ARV treatment is stopped. By working on a system called “induce and reduce”, this host cells can become recognised targeted and eliminated.

With the delevopment of solutions, there seems to be light at the end of the tunnel and we are winning the fight against HIV. However it is important to know that prevention remains the primary target. Get tested regularly, use protection and for those already affected, always remember to take your medications.

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