Advances in HIV Treatment: How AIDS Cocktails Work
Preferred PI-Based Regimens continued...
Atazanavir/ritonavir has long been a favorite PI in terms of tolerability, effectiveness, and once-daily dosing. Because darunavir/ritonavir also has these features, it has also come into play the last three years, Gandhi says. But it also has an advantage over atazanavir/ritonavir in terms of drug interactions. Darunavir can be given with antacids, and atazanavir really can't. "For all those reasons, it's gaining in popularity and is incredibly potent,” Ghandi says.
A preferred regimen for pregnant women is lopinavir (Kaletra) boosted with low-dose ritonavir (twice daily) + zidovudine (AZT, Retrovir, ZDV) + lamivudine (3TC, Epivir). Zidovudine and lamivudine are also available as a combination pill (Combivir).
Preferred Integrase-Based Regimen
Medications: Raltegravir (Isentress) + tenofovir + emtricitabine
The only example in its class of integrase inhibitors, raltegravir has also done well since approval, according to Gandhi. But in "head-to-head" trials with efavirenz, it appears to not be quite as effective. "It has great advantages in terms of tolerability -- it causes very few side effects -- but its disadvantage over the other three is that it is currently a twice-a-day drug,” Gandhi says.
Getting the Right HIV Treatment: How to Talk to Your Doctor
Which HIV/AIDS cocktail you and your doctor choose depends on factors such as:
- Your lifestyle
- Your viral load
- The status of your immune system (CD4 count)
- If you have resistance to any drugs (which can be checked before you begin a regimen)
- Other conditions you have
- Other medications you're taking
"Become educated about the preferred options," Taifo says. Each is unique, with its own set of advantages and disadvantages. Some are taken in a combination once-a-day pill. Others follow a different, more involved schedule. Some cause minimal side effects. Others are more likely to cause noticeable or long-lasting complications. When your doctor prescribes a regimen, ask, "Why this one, of all the options?"
"Make sure your doctor understands who you are -- your family history, your risk for heart disease, your preferences," Taifo says. "These all can be factors in the selection of a regimen."
Enhancing the Effectiveness of AIDS Cocktails
"All these regimens work -- they work if patients take them," Taiwo says. This is the most critical thing to understand, he adds: Resistance to HIV medications doesn't just happen and is unlikely if you take your HIV/AIDS cocktail as directed. But it can happen if you end up with too little medication in your blood and uncontrolled infection. Then it also becomes a public health issue because resistant strains can be passed to others, as well.
"Those who do best are almost obsessive about their medications," Taiwo says. "They incorporate it into their lifestyle and accept it as a way of life -- they do very well."
What seemed inconceivable not that long ago is eminently possible today. You can take HIV cocktails for a long time and live a good life.