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HIV Treatment Overview
This document provides an introduction to HIV treatment. It discusses current treatment guidelines which recommend antiretroviral therapy for all HIV-positive individuals regardless of CD4 count. Early treatment can prevent immune system damage and reduce inflammation-related health issues. The goals of treatment are to suppress the virus and improve health. Common drug classes and their mechanisms of action are described. Adherence is important to avoid resistance, and side effects usually diminish over time. Ongoing care and research aim to further simplify regimens and eventually find a cure.
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HIV Treatment Overview
- 1. HIV Treatment: AnIntroduction October 20, 2013 Dr. Joanna Eveland, MS, MD HIV Medical Director, Clinica Esperanza/Mission Neighborhood Health Center
- 2. Objectives When, Why andWhat treatment to start Overcoming side effects Working with your healthcare providers to get the most out of treatment
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- 5. 2013 Treatment Guidelines Antiretroviraltherapy is recommended for all HIV+ individuals regardless of CD4 count
- 6. Why Treat Early? Prevent irreversible damage to the immune system Reduce “Inflammation” to prevent heart disease, cancer, premature aging Treatment is prevention Reduce the size of the “HIV reservoir”, maybe making HIV easier to cure someday
- 7. Don’t start medsuntil… You feel ready You are well engaged in care You can commit to taking your meds regularly You feel that other life factors and potential barriers to adherence (drugs, drama, mental health) are under control
- 8. We have along way to go…
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- 11. Where we arenow…
- 12. Take Home Points HIV treatment continues to improve- for the better! Each person’s combination of medicines is different KNOW what you take, and why
- 13. Know What You’reTaking HIV drugs have two, sometimes three, different names Scientific name, brand name, chemical name Zidovudine = Retrovir = AZT Some tablets contain more than one ingredient Atripla = tenofovir + emtricitabine + efavirenz
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- 15. General Principles Goals:less pills, less times/day, less side effects Use at least 3 drugs, 2 classes of medicines Treatment is individualized- 4 recommended 1st line combos, lots of alternate regimens Sometimes 3 isn’t enough Your Protease Inhibitor may need a “Booster” Drug resistance usually = more pills
- 16. Treatment Principles: Chinese MenuMetaphor “Two scoops of rice plus chicken or beef” In other words, usually 2 “nukes”(NRTI) (2 scoops of rice) plus – 1 partner drug (main dish) Protease Inhibitor (beef) “non-nuke” NNRTI (chicken)
- 17. The Drugs… Each attacksthe virus at a different point…
- 18. Where Do HIVDrugs Act?
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- 20. NRTIs Continued Backboneof treatment Older drugs are more toxic (AZT, “D-drugs”) Peripheral neuropathy Lactic acidosis Pancreatitis Lipodystrophy Watch kidney function with Tenofovir
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- 22. NNRTIs: Pros andCons ADVANTAGES Ease (low pill burden) Less metabolic effects Well tolerated DISADVANTAGES No lipodystrophy, less dyslipidemia Resistance develops quickly if <95% adherent Single mutation Cross resistance among NNRTIs Rash; hepatotoxicity
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- 24. PIs: Pros andCons ADVANTAGES DISADVANTAGES High potency Once daily dosing for many Less susceptible to resistance Second-line therapy when NNRTI fails Metabolic complications - Increased cholesterol, blood sugar GI side effects - Diarrhea, nausea Drug interactions – Statins, viagra, antiseizure, many
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- 26. Integrase Inhibitors 3agents- more to come! Well tolerated, less metabolic effects and drug interactions than other classes Can cause rash, hepatotoxicity
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- 28. Entry Inhibitors Currentlyused as salvage therapy for those with drug resistance Fuzeon is injectable, rarely used Maraviroc is well tolerated, requires CCR5 receptor on CD4 cells (not everyone has this) More to come in this class
- 29. Once a dayFixed Dose Combos Name Pros Cons Atripla Lots of experience using it • Neuropsych side effects • Don’t stop without planning Complera Well tolerated • Only studied in treatment naïve • Not for use if VL >100K • Take with food • Can’t take PPIs Stribild Well tolerated • Only studied in treatment naïve • Drug interactions • Watch kidney function • Nausea
- 30. Side Effects Tendto be worst in the first 2 months of therapy Severe side effects are a reason to change medications Your expectations shape your experience
- 31. What If IMiss a Pill? Risk of resistance increases with missing more than 1-2 doses/month If you miss a dose, try and learn from it If stopping your meds All or none Let us know!
- 32. Working With YourProvider You deserve great care Find the right fit Educate yourself Be engaged in care- regular visits Uninsured? You can still get care!
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- 34. Focus on Wellness Manage stress Exercise regularly Quit smoking Reduce harmful drug or alcohol use Build a supportive community Define and achieve your personal goals
- 35. HIV Cure Research Theraputic vaccines Genetherapy BM Transplants Early/better treatment Paths to an HIV Cure “Shock and Kill” HIV infected cell suicide
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- 37. Thanks To youfor taking care of yourself! The advocates and activists who gave us these treatments My patients
- 38. More Questions? Dr. JoannaEveland Clinica Esperanza 240 Shotwell St., SF (415) 431-3212 – Clinic Info (415) 552-3870 # 303 –My extension [email protected]