The first six
years of AIDS (1981-1987) saw more than 40,000 deaths and 50,000 new infections
without any FDA approved drug therapy. In 1987, Azidothymidine (aka AZT or
Retovir) became an answer to the staggering numbers of deaths from AIDS and new
HIV infections over the last several years. AZT had a previously pharmaceutical
use as an early anti-Cancer fighting agent known decades earlier as Compound S.
AZT was hurried through the FDA hoops and hurdles in an unprecedented 25 months
and “marked the introduction of the first effective weapon against the virus [HIV]
and AIDS itself, what eventually would become a key element of the multi-drug
cocktail of HAART itself.” (1)
AZT is not
without its controversy that cannot be overlooked. In short, thousands of
people were suffering and dying from AIDS in such short periods that a drug
therapy had to be offered. AZT offered no cure and little to more than a year
or so prolonged life to those suffering; consequently, its cost was
astronomical at $10,000 dollars for a year’s therapy. AZT’s efficacy is a
double-edged sword. The drug helps to prevent the HIV virus from invading,
genetically altering T cells; however, the drug at high doses inhibits healthy
cell division creating a myriad of health concerns. Drug resistance to AZT is
common and is not tolerated well by most. AZT as a singular drug therapy is rarely
prescribed since the introduction of HAART (highly active antiretroviral
therapy). (1)
HAART
In 1996, fifteen
years into the AIDS crisis, HAART revolutionized the HIV era by presenting
multiple drug regimens meant to enhance the healing effects of AZT (often
listed in drug cocktails as Retovir). HAART has expanded to include six classes
of drugs that stops the genetic replication of the HIV viron, lowering the
viral load to an undetectable level, as well as, decreases the ability for the
virus to continue to alter itself into more strains than already
identified.
Since the
introduction of HAART, the classes of drug therapies continue to become more
robust than ever with more than 30 approved drugs in 6 different classes. With
such a large selection of therapies to test and try, it helps to deal with
those who build up drug resistance. Along with a wide selection of drug
therapies the more recent additions have decreased side-effects and less strict
dosing provisions. The most exciting is the ‘One Pill a Day’ options (All in
One Combination Tablets), which is a HAART cocktail in one pill and taken once
a day. This is a blessing to those of us whom have never had to take anything
other than one pill a day and those who have had to take common cocktails of 5
to 10 pills throughout the day on a strict schedule.
Currently
Approved Drugs for HIV
HIV is a
retrovirus: a virus that needs a host to invade and, through genetic mutation,
replicate itself. HIV drug therapies are
called antiretrovirals because they attack the HIV retrovirus and they are
highly effective (active). HAART drugs have a corresponding stage of HIV
replication in which the drugs in that class target. The six classes of HAART are
(as of March 2015):
- 4 All in One Combination Tablets (Multiclass Combination Products)
- 11 Protease Inhibitors (PIs)
- 11 Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
- 5 Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
- 2 Early Inhibitors including Fusion Inhibitors
- 2 Integrase Inhibitors
The connection between the
phase of HIV replication and corresponding HAART drug needs an understanding of
the 8 stages of the HIV replication process, which will be discussed in another
blog. This should, if anything else shows the progression from a poisonous
cancer fighting drug that often did more damage than good, to multiple all in
one tablet options, and, hopefully, the cure will be in our future. To find a
comparative chart of FDA approved drugs: CLICK HERE.
Bryan Heitz
Risk Reduction Specialist
