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What is The Antiretroviral Therapy?

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The Antiretroviral Therapy means treating HIV infection with some drugs. Because the HIV virus is a retrovirus, the drug is commonly referred as an antiretroviral drug (ARV). ART does not kill the HIV virus, however antiretroviral therapy can slow the growth of viruses. Time slowed the growth of the virus as well as diseases caused by HIV virus.The principle of ARV provision is a must use three (3) types of drugs that all three be absorbed and be in a therapeutic dose in the blood, known as Highly Active Antiretroviral Therapy (HAART) or ART, or antiretroviral therapy.

What is the HIV Virus Life Cycle ????

There are several steps in the HIV virus life cycle:
1. Free virus circulates in the blood stream
2. The HIV virus binds to the cell
3. The HIV virus penetrates the cell and empties its contents into the cell
4. HIV virus genetic code is modified from the form of RNA into DNA with the aid forms by the enzyme reverse transcriptase
5. The HIV DNA mixed with the DNA of cells with the assistance by the integrase enzyme. With this integration of these cells to become infected with HIV virus
6. When the infected cell reproduces, it activates the HIV DNA and makes the raw material for new viruses
7. All the materials needed to create new virus collected
8. The immature virus pushes out of the infected cell in a process called (bulge) "budding"
9. Millions of immature virus released from infected cells
10. The new virus becomes ripe, raw materials are cut by the protease enzyme and assembled into a virus that is ready to work

ARVs are approved in the US

Class of anti-HIV drugs are Nucleoside Reverse Transcriptase Inhibitors (NRTIs), also called nucleoside analogues. These drugs inhibit the fourth step above that of HIV genetic material changes the form of RNA into DNA is needed in the next step. Drugs in this class are approved by the US and they are made are:
1. 3TC / Lamivudine
2. Abacavir / ABC
3. AZT / Zidovudine
4. d4T / Stavudine
5. ddI / didanosine
6. Emtrisitabin / FTC
7. Tenofovir / TDF; nucleotide analog

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) inhibits the same steps in the cycle of HIV but with other means. These drugs are approved by the US are:
1. Delavirdin (DLV)
2. Efavirenz (EFV)
3. Etravirin (ETV)
4. Nevirapine (NVP)
5. Rilpivirin (RPV)

Protease Inhibitors (PIs) inhibit the tenth step with material cut to fit a new virus to create a new virus. These drugs are approved by the US are:
1. Atazanavir (ATV)
2. Darunavir (DRV)
3. Fosamprenavir (FPV)
4. Indinavir (IDV)
5. Lopinavir (LPV)
6. Nelfinavir (NFV)
7. Ritonavir (RTV)
8. Saquinavir (SQV)
9. Tipranavir (TPV)

Entry inhibitors prevent HIV binding and pemasuka in cells by inhibiting the second step of the life cycle. These drugs are:
1. Enfuvirtid (T-20)
2. Maraviroc (MVC
Integrase inhibitor (INI) these drugs prevent the integration of the genetic code of HIV with the genetic code of cells by inhibiting the fifth step of the life cycle. These drugs are:
1. Dolutegravir (DTG)
2. Elvitegravir (EGV)
3. Raltegravir (RGV)
However elvitegravir is only approved as ingredients in Stribild, a combination pill with cobicistat, emtricitabine and tenofovir.

How does this medicine TAKEN ???

ARV drugs are generally used in combination with three or more antiretroviral drugs from more than one class. This is known as combination therapy or HAART. ART works much better than just one ARV alone. How to use these drugs to prevent the emergence of resistance.

What's Resistance Against Drugs ???

When HIV multiplies, the majority of new HIV seeds may be slightly different than the original. These different types are called mutants. Most mutants immediately die tatapi some of which continue to multiply, although we remain on ART mutant is apparently resistant to the medicine. If this happens, the drugs do not work anymore. It is called "developing resistance" to the drug. If only one type of virus used drugs are easily develop resistance to it. Therefore, the use of only one type of ARVs are not recommended. But if two drugs are used mutant virus should be superior to the two drugs at the same. And if three drugs are used the possibility of emergence of mutants that can be at once superior to all of them very small. The use of triple combination means takes much longer to develop resistance.

Can this medicine cure AIDS??

Currently there is no cure HIV infection. ARVs reduce viral load is the amount of HIV virus in the bloodstream. If your viral load is lower, we stay healthy longer. We are also less likely to transmit the virus to others. Viral load some people become so low that it can not be measured by viral load tests called "undetectable". This does not mean the virus is gone and does not mean the person is "cured".

When should we start ARV Therapy??

Early initiation of antiretroviral therapy is clinically proven to be beneficial, useful for the prevention, increase life expectancy and decrease the incidence of HIV infection in the population. Recommendations initiation of antiretroviral therapy in adults and children = 5 years are:
1. Initiation of ART in HIV infected persons WHO clinical stage 3 and 4, or if the CD4 count = 350 cells / mm³
2. Initiation of ART regardless of WHO clinical stage and regardless of CD4 count
• TB coinfection
• Co-infection with Hepatitis B
• Pregnant and lactating mothers infected with HIV
• People infected with HIV are HIV negative partner (serodiscordant couples), to reduce the risk of transmission
• LSL, PS, transvestite or IDU
• The general population in areas with widespread HIV epidemic
Recommendations initiation of antiretroviral therapy in children <5 years ie regardless of WHO clinical stage and regardless of the number CD4nya.
TB treatment should be started first, then ARV drugs are given within 2-8 weeks after starting TB drugs without stopping TB therapy.

What type of ART Drugs that we should wear?

ARV been based HIV drug resistance, our health (eg no liver or kidney disease) and lifestyle factors. But not all of the above ARVs available in Indonesia so the selection is based on antiretroviral treatment guidelines. While ART alloys generally well tolerated, each ARV same as other drugs may cause side effects. The side effects of each person is different, and we, along with doctors to decide which drugs to choose. Adherence to antiretroviral therapy is very important. The viral load test is used to determine whether the therapy works as it should. If your viral load does not go down, or down but rose again, maybe we should switch to another drug combination.


Source : Peraturan Menteri Kesehatan Republik Indonesia Nomor 87 Tahun 2014 Tentang Pedoman Pengobatan Antiretroviral












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