Antiretroviral therapy (ART) involves a combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). This combination both decreases viral replication but also reduces the risk of viral resistance emerging

Following the 2015 BHIVA guidelines it is now recommended that patients start ART as soon as they have been diagnosed with HIV, rather than waiting until a particular CD4 count, as was previously advocated.

HAARTs

Indications to Start Thearpy:

CD4 ~350 (500 for USMLE) and viral load ~500000 copies

symptomatic patients with any CD4 count or viral load

pregnant (all patients, any stage, any CD4)

needle-stick to infected patient

Typical Regimens:

Tenofovir + Emtricitabine + Efavirenz

Tenofovir + Emtricitabine + Atazanavir (or darunavir)*

• small amount of Ritonavir is added to boost the level of the other protease inhibitors

An ARV regimen for a patient who is treatment-naive generally consists of a dual NRTI regimen administered in combination with a third active ARV drug from one of three drug classes: an INSTI, an NNRTI or a PI with a PK enhancer.

ARVs