Treatment and Prevention of HIV Infection

Which drugs belong to nucleoside reverse transcriptase inhibitors?

Nucleoside and nucleotide reverse transcriptase inhibitors include drugs that are false analogs of natural nucleosides. This group includes:

• Zidovudine (azidothymidine) — a thymidine analog.
• Stavudine — a thymidine analog.
• Phosphazide — a nucleotide analog of thymidine.
• Lamivudine — a cytidine analog.
• Emtricitabine — a cytidine analog.
• Zalcitabine — a cytidine analog.
• Didanosine — an adenine analog.
• Tenofovir — a nucleotide analog of adenine.
• Abacavir — a guanine analog.

Fixed combinations of NRTIs are also used, for example, zidovudine + lamivudine or abacavir + lamivudine.

Which drugs belong to HIV protease inhibitors?

HIV protease inhibitors include peptidomimetic substances that cause inactivation of the viral aspartyl protease. This group includes the following drugs:

• Indinavir — a protease inhibitor.
• Saquinavir — the first drug from the protease inhibitor group.
• Atazanavir — a protease inhibitor.
• Darunavir — a protease inhibitor.
• Lopinavir — a protease inhibitor.
• Ritonavir — a protease inhibitor.
• Fosamprenavir — a protease inhibitor.

In clinical practice, drug combinations are frequently used, for example, lopinavir + ritonavir, darunavir + ritonavir, atazanavir + ritonavir.

Which opportunistic infections are characteristic of the AIDS stage?

The AIDS stage is characterized by the development of severe opportunistic infections of protozoal, fungal, bacterial, and viral origin. The main ones include:

• Protozoal and parasitic — cerebral toxoplasmosis, cryptosporidiosis, strongyloidiasis (Strongyloides stercoralis), leishmaniasis.
• Fungal — Pneumocystis pneumonia (Pneumocystis jirovecii), candidiasis (Candida species), cryptococcosis (Cryptococcus neoformans), aspergillosis, histoplasmosis.
• Bacterial — tuberculosis (the main cause of death), bacterial pneumonia (most often Streptococcus pneumoniae), bacillary angiomatosis, syphilis.
• Viral — cytomegalovirus infection (CMVI).

Which drugs belong to non-nucleoside reverse transcriptase inhibitors?

Non-nucleoside reverse transcriptase inhibitors include drugs that suppress viral replication by acting on the reverse transcriptase enzyme. This group includes:

• Nevirapine — a non-nucleoside reverse transcriptase inhibitor.
• Efavirenz — a non-nucleoside reverse transcriptase inhibitor.
• Etravirine — a non-nucleoside reverse transcriptase inhibitor.
• Rilpivirine — a non-nucleoside reverse transcriptase inhibitor.

Some of these drugs, such as rilpivirine, may be used as part of fixed-dose combination antiviral agents.

Which drugs belong to HIV integrase inhibitors?

HIV integrase inhibitors include drugs that prevent the integration of viral DNA into the host cell's genetic material. This group includes:

• Raltegravir (Isentress) blocks the catalytic center of the integrase enzyme.
• Dolutegravir has the highest degree of CNS penetration.
• Elvitegravir is used as part of fixed-dose combination drugs.
• Bictegravir is also used as part of fixed-dose combinations.

Which antiretroviral therapy regimens are considered first-line?

First-line antiretroviral therapy regimens include starting combinations consisting of three antiretroviral drugs:

• Backbone — two nucleoside or nucleotide reverse transcriptase inhibitors (2 NRTIs).
• Third drug — one agent from another group of choice.

Possible starting therapy formulas:

• 2 NRTIs + 1 protease inhibitor (PI);
• 2 NRTIs + 1 non-nucleoside reverse transcriptase inhibitor (NNRTI);
• 2 NRTIs + 1 integrase strand transfer inhibitor (INSTI).

Monotherapy, dual therapy, or three NRTIs are not recommended.