COMBATING HIV & AIDS– A REVIEW ON DRUG SIDE-EFFECT PROFILE

ABOUT AUTHOR
Sushama Rawat
Department of Pharmaceutical Chemistry,
Nirma University, Gujarat, India
rawatsushama86@gmail.com

World AIDS Day is distinguished on 01^st December every year to increase awareness about HIV/AIDS and to demonstrate international unity in the face of the endemic. The day is an occasion for communal and private partners to disseminate information about the status of the pandemic and to encourage progress in HIV/AIDS prevention, treatment and care around the world, predominantly in high prevalence countries.

Key facts
1. HIV continues to be a major global public health issue, having claimed more than 25 million lives over the past three decades.
2. There were approximately 35.3 [32.2– 38.8] million people living with HIV in 2012.
3. HIV infection is usually diagnosed through blood tests detecting the presence or absence of HIV antibodies.
4. There is no cure for HIV infection. However, effective treatment with antiretroviral drugs can control the virus so that people with HIV can enjoy healthy and productive lives.
5.  In 2012, more than 9.7 million people living with HIV were receiving antiretroviral therapy (ART) in low and middle-income countries.

Between 2011-2015, WHO World AIDS Day has the theme: "Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths".

Antiretroviral therapy (ART) is cure of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs. The standard treatment consists of a combination of at least three drugs (often called “highly active antiretroviral therapy” or HAART) that hold back HIV replication. Three drugs are used in order to diminish the probability of the virus emergent resistance. ART has the prospective both to lessen mortality and morbidity rates among HIV-infected community, and to recover their quality of life.

There are diverse classes of anti-retroviral drugs aimed at preventing replication of HIV at various points of the life cycle:
1. Nucleoside or nucleotide reverse transcriptase inhibitors - abacavir, didanosine, emtricitabine, lamivudine, stavudine, and tenofovir.
2. Non-nucleoside reverse transcriptase inhibitors - efavirenz, etravirine, and nevirapine.
3. Protease inhibitors - atazanavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir.
4. Integrase inhibitors - raltegravir.
5. Fusion inhibitors - enfuvirtide.
6. CCR5 antagonists - maraviroc.

Antiretroviral medicines work by stopping the HIV from making copies of itself. The amount of virus in the body (viral load) is decreased. This gives immune system some time to become strong again and allows the body to make more CD4 T cells. The aim of treatment is to reduce the viral load to very low levels for as long as possible, and to increase the number of CD4 T cells to a normal level. This in turn means that the patient is less likely to get infections.

The medicines in each class work in slightly different ways, but all work to stop the HIV from replicating itself. They work best when they are prescribed in combination.

Side Effects of HAART (refer the Table)
Side effects are a secondary, typically undesirable effect of a drug or medical treatment.

Antiretroviral medicines can have many side effects. Some can be very serious, even life-threatening, such as liver failure or inflammation of the pancreas (pancreatitis). Most are not serious but may reduce the quality of life.

Because highly active antiretroviral therapy (HAART) requires the use of 3 or more antiretroviral medicines, some side effects are likely to occur, including: nausea or vomiting, diarrhea, abdominal pain, severe fatigue, muscle aches, rash and fever.

HIV medications can induce anemia, neutropenia, and idiopathic thrombocytopenic purpura.

Other adverse systemic affects of HAART include an increased risk of hyperglycemia and dyslipidemia associated with metabolic syndrome. Abdominal obesity and insulin resistance or glucose intolerance are the main risk factors for dyslipidemia associated with metabolic syndrome. These patients are at a greater risk for Type 2 diabetes mellitus and cardiovascular disease. Therefore, it is important to be aware of these additional systemic effects and monitor patients' sugar and cholesterol levels accordingly.