Antiviral Drugs For Hiv/Aids

  • Soumya Iyer International Baccalaureate, Natural Sciences, Global Schools Foundation
  • Taylor Mckevitt MSc Science Communication, University of Manchester
  • Regina Lopes Senior Nursing Assistant, Health and Social Care, The Open University

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Introduction

HIV (Human Immunodeficiency Virus) targets the body’s immune system leading to decreased protection against diseases and infections. If left untreated, HIV can transform into AIDS (Acquired Immunodeficiency Syndrome). Although HIV can be spread from one person to another, AIDS itself cannot be spread. AIDS develops over time in someone who has HIV because the virus damages their immune system. 

Importance of antiviral drugs in HIV/AIDS treatment

Antiviral drugs can reduce the damage of various parts of the immune system. This will slow down the progression of HIV into AIDS. However, it is important to note that HIV does not have a cure and these drugs are prescribed to reduce symptoms and transmission.

Understanding HIV/AIDS

HIV transmission and its impact on the immune system

HIV is transmitted between individuals through bodily fluids such as breastmilk, semen and blood. It can only be transferred by direct contact with bodily fluids. Hugging or sharing food cannot cause HIV transmission. 

Once it is in the body the individual develops flu-like symptoms such as fever, rashes and sore throat. In the early stages, not everyone experiences these symptoms till the virus concentration in their blood reaches a certain threshold.

Role of antiviral drugs

Types of antiviral drugs used in HIV/AIDS treatment

Antiviral drugs are a type of medication designed to fight off pathogenic viruses. They help minimise symptoms as well as reduce chances of transmission. Some examples of antiviral drugs to alleviate HIV transgression include Efavirenz, Darunavir, Ritonavir and more.

Nucleoside reverse transcriptase inhibitors (NRTIs)

Reverse transcriptase is used by the virus to convert its RNA into a DNA form. By doing this, it can easily replicate within the host organism NRTIs prevent the function of this enzyme, which means the virus can’t make more copies of itself

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

These drugs also attack the same enzyme as NRTIs, which is the reverse transcriptase, But they bind to a different area of the virus and change its shape. They are a form of non-competitive inhibitors.

Protease inhibitors (PIs)

These drugs block an enzyme called protease. Protease is an enzyme that is necessary for young HIV to mature and produce infectious viral particles. It solves the problem of virus-causing symptoms as well as virus replication which can lead to the progression of HIV.

Integrase inhibitors (INSTIs)

The integrase enzyme plays an integral role in the virus integrating its genetic material into the host’s DNA (CD4 cells). Therefore the inhibition of this enzyme by the INSTIs helps prevent the virus from making copies within the CD4 cell.

Entry inhibitors

For HIV to infect CD4 cells, there needs to be an interaction between the surface proteins of HIV and CD4 cells. Entry Inhibitors prevent HIV from entering into the CD4 cells by attaching to proteins of CD4 cells or on the surface of HIV cells. This prevents HIV from infecting CD4 cells in the first place.

Effectiveness and limitations

Success rates and effectiveness of antiviral drugs in HIV/AIDS treatment

The use of antiviral drugs for HIV/AIDS treatment has improved individuals' lifestyles by making their condition more manageable. Since most of these drugs target replication and enhancement of the virus, they suppress the symptoms associated with infectious viral particles. Consequently, their lack of action allows for better growth of CD4 cells that are essential for fighting pathogens and strengthening the body’s immune system. Additionally, the use of 3 drugs at different processes of the virus’ life cycle has shown 60-80% decrease in AIDS as well as hospitalisation FDA has begun approving drugs for people at different age groups or with existing conditions to allow widespread availability of HIV medication. These treatments are usually monitored by checking CD4 cell count monthly and viral load screening. 

Challenges and limitations faced in antiviral therapy

Drug resistance

HIV has a high mutation rate therefore not completing a full course of treatment or missing some doses can lead to increased resistance to the drug type. These mutations are introduced into the viral genome during replication. Subsequently, the drugs are never prescribed alone as the virus could easily develop resistance to that specific type. This is why a lot of combinations tackle various parts of the virus lifecycle to prevent chances of resistance. Another technique used to prevent resistance is adhering to the treatment regime and conducting regular checks.

Side effects

Different types of drugs can have varied effects Some of the most common side effects include nausea, rash, dizziness and cold. This can depend on the dosage and combination of the aforementioned drugs. However, it is important to note that these effects do not occur when the individual develops resistance to the drugs because they no longer respond to them.

Current research and development

Ongoing advancements in antiviral drug development for HIV/AIDS

By 2030, the CDC wants to achieve 90-90-90 which involves diagnosing at least 90% of the cases, treating 90% of those diagnosed with antiviral therapies and suppressing the virus in 90% of the cases. In addition to this, companies are also developing drugs to optimise treatments and increase availability to those in severe need.

Accessibility of antiviral drugs in different regions and populations

There have been recent advancements and investments to improve the accessibility of these drugs to different populations across the globe. Through these increased efforts, increasing awareness and developing new drugs, approximately 76% of individuals infected with HIV now have access to antiviral drugs, which is a 24% improvement since 2010.

Summary

  • Human Immunodeficiency virus (HIV) infects the body’s immune system and, if left untreated, can develop into AIDS which is a life-threatening condition.
  • HIV can only be transmitted by transfer of bodily fluids into the bloodstream e.g blood transfusion, semen and sharing of needles.
  • It does not have a cure but there are antiviral drugs that slow down its progression and reduce the chances of HIV developing into AIDS.
  • The antiviral drugs work by hindering various parts of HIV’s life cycle within the host cell, this reduces its concentration in the body.
  • There are 5 main types of antiviral drugs: Nucleoside reverse transcriptase inhibitors, Non-nucleoside reverse transcriptase inhibitors, Protease inhibitors, Integrase Inhibitors and Entry Inhibitors.
  • The drugs need to be delivered in combinations to prevent resistance development and increase the chances of suppression. A study showed that a 3-drug combination has proven efficient.
  • There have been many efforts to manage HIV, and in the near future, the CDC aims to extend these efforts to reach 90% of the population

References

  1. Kemnic TR, Gulick PG. HIV Antiretroviral Therapy. [Updated 2022 Sep 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513308/
  2. Nucleoside reverse transcriptase inhibitor (NRTI): NIH [Internet]. [cited 2023 Dec 12]. Available from: https://clinicalinfo.hiv.gov/en/glossary/nucleoside-reverse-transcriptase-inhibitor-nrti 
  3. HIV and AIDS [Internet]. World Health Organization; [cited 2023 Dec 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids 
  4. About HIV/AIDS [Internet]. Centres for Disease Control and Prevention; 2022 [cited 2023 Dec 14]. Available from: https://www.cdc.gov/hiv/basics/whatishiv.html
  5. Fighting viruses: How do antivirals work? [Internet]. [cited 2023 Dec 13]. Available from: https://scienceexchange.caltech.edu/topics/covid-19-coronavirus-sars-cov-2/antiviral-drugs
  6. professional CC medical. Antivirals: Antiviral medication, what they treat & how they work [Internet]. [cited 2023 Dec 14]. Available from: https://my.clevelandclinic.org/health/drugs/21531-antivirals
  7. Hiv.gov. Symptoms of HIV [Internet]. HIV.GOV; 2022 [cited 2023 Dec 14]. Available from: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv/ 

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Soumya Iyer

International Baccalaureate, Natural Sciences, Global Schools Foundation

Soumya is currently an undergraduate student pursuing BSc Biological and Biomedical Sciences (joint degree with National University of Singapore) at the University of Dundee, Scotland. As someone very passionate about scientific communication, she’s undertaken this internship following her previous experience in writing scientific reports.

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