Acquired immunodeficiency syndrome (AIDS) is a condition caused by a progressed state of infection by the human immunodeficiency virus (HIV). The retrovirus can be transmitted through bodily fluids such as blood, semen, breast milk, and vaginal fluids via the bloodstream or mucous membranes (Moss; Maartens et al.; Simon et al.).
Infection by HIV typically has four stages. The first stage is acute or primary infection which may last up to a few weeks, during which the infected person may either be asymptomatic or have flu-like symptoms such as fever, rash, malaise, body aches, chills, and swollen lymph nodes. Progression of the disease from initial infection occurs at varying rates among patients. A latent or asymptomatic period usually follows primary infection and may last up to 10 years or more. During this stage the virus is not dormant and HIV antibodies have detectable levels in the blood. Moreover, the patient may exhibit minor symptoms such as swollen glands and some skin problems (Moss; Naous).
After the latent stage, HIV infection becomes symptomatic and is marked by progressive deterioration of the patient's immune system. Weakening of the patient's immune system is caused by a viral mutation, excessive tissue damage especially of the lymph nodes, and destruction of thymus lymphocytes or T cells. Progression to AIDS is commonly marked by various opportunistic infections, especially by etiologic agents that may not cause significant harm in healthy individuals. These infections may include diarrhea, pneumonia, eye infections, and meningitis. Severely compromised immune system is also at risk for developing cancers such as cervical cancer, sarcoma, and lymphoma. Other conditions associated with HIV/AIDS are HIV encephalopathy (AIDS dementia), lymphoid interstitial pneumonia, and HIV wasting syndrome (rapid weight loss and weakness) (Moss; Naous).
While the symptoms of HIV infection and AIDS may be managed, there is no actual cure for the disease. As such, the standard treatment for patients who are HIV+ or have AIDS is antiretroviral therapy (ART). Antiretroviral drugs minimize HIV levels in the body to prevent degradation of the immune system and to allow some degree of recovery. Antiretrovirals are usually taken in combination to prevent (or at least slow down) the development of resistance of the virus to the drugs. Treatment with three or more anti-HIV drugs is commonly referred to as highly active antiretroviral therapy (HAART) (Maartens et al.; Simon et al.).
There are over 20 antiretroviral drugs that have been approved for treatment of HIV/AIDS. They work through various mechanisms that target the viral entry and replication pathways and are classified according to their mode of action. Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) compete against regular nucleoside/nucleotide monomers during viral replication and cause chain termination of the viral DNA because they lack the essential sugar moiety that is essential for the formation of a phosphodiester bond within a growing nucleic acid strand. On the other hand, non-nucleoside reverse transcriptase inhibitors (NNRTIs) bind to the viral enzyme reverse transcriptase, which changes the spatial conformation of the enzyme’s active site and prevents its activity in replication. Integrase inhibitors target the enzyme strand transfer activity of the viral enzyme integrase. Protease inhibitors (PIs) inhibit the cleavage of polyprotein precursors vital to virion maturation. Finally, entry inhibitors prevent the entry of HIV into host cells by inhibiting or disrupting specific targets or steps within the viral entry process (Arts and Hazuda).
Antiretroviral therapy has improved survival rates of HIV/AIDS patients but it is not without risks. Side effects of antiretroviral drugs are extensive and they have numerous adverse interactions with other drugs. Common drugs which have interactions with antiretroviral therapy include anticonvulsants, gastrointestinal medications, cardiac medications, and some psychiatric medications. Some common side effects of antiretroviral drugs are nausea, loss of appetite, gastrointestinal issues, lipid abnormalities, rash, liver toxicity and many others (Reust).
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Reust, C. E. "Common Adverse Effects of Antiretroviral Therapy for HIV Disease." American Family Physician 83.12 (2011): 1443-1451. Web. 19 Apr. 2015.
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