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Antiretroviral Therapy (ART)

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Antiretroviral therapy (ART) has made a dramatic impact on the quality of life of people living with HIV/AIDS by decreasing the associated morbidity and mortality. ART should be a part of a program of comprehensive care and support. Including these drugs as part of HIV clinical care makes HIV infection a more manageable, chronic illness. People living with HIV/AIDS benefit by having restored health, economic productivity and social functioning. In communities in resource-constrained countries, providing ART demonstrates respect for people living with HIV/AIDS, and has the potential to decrease stigma and boost prevention efforts.

Today fewer than one percent of people living with HIV/AIDS in the most affected areas of the world have access to antiretroviral drugs. It is now a challenge to continue to advocate for decreased prices of these drugs and increased health service capacity to optimize their sustained, safe and effective use.

Combining at least three drugs from the various classes of ARVs into a "cocktail" typically produces a dramatic reduction in viral load (the level of virus in the blood) and prevents further immune damage. This combination is called "highly active antiretroviral therapy" (HAART). 

Each class of ARV attacks the virus at a different stage of its replication, preventing it from replicating further or, at a minimum, slowing down replication. 

The common classes of ARVs are: 
   
  • nucleoside reverse transcriptase inhibitors such as zidovudine (AZT, lamivudine (3TC) and abacavir
  • non-nucleoside reverse transcriptase inhibitors such as nevirapine and efavirenz 
  • protease inhibitors such as indinavir, ritonavir and lopinavir
Use of the drugs is influenced by their cost, side effects, drug resistance, drug interactions, schedule and storage requirements and the necessity of lifelong adherence.

Starting ART means making a lifelong commitment to medication and enduring the almost universal initial period of unpleasant side effects.

In general, regimens without protease inhibitors are easier to take. Others require taking medication once or twice a day and do not require strict timing, taking them on an empty stomach or large fluid intake.