Disease primer: Human immunodeficiency virus (HIV)

Human immunodeficiency virus (HIV) is a virus that attacks the body’s immune system. Acquired immunodeficiency syndrome (AIDS) occurs at the most advanced stage of infection.

HIV targets the body’s white blood cells, weakening the immune system. This makes it easier to get sick with diseases like tuberculosis, infections and some cancers.

Diagnosis

  • Rapid diagnostic tests that provide same-day results.

Most widely used HIV diagnostic tests detect antibodies produced by a person as part of their immune response to fight HIV. In most cases, people develop antibodies to HIV within 28 days of infection. During this time, people are in the so-called “window period” when they have low levels of antibodies which cannot be detected by many rapid tests, but they may still transmit HIV to others. People who have had a recent high-risk exposure and test negative can have a further test after 28 days.

Treatment

HIV can be prevented and treated with antiretroviral therapy (ART). Untreated HIV can progress to AIDS, often after many years.

Current ART options are combinations (or “cocktails”) consisting of at least three medications belonging to at least two types, or “classes”, of antiretroviral agents. There are eight classes of antiretroviral agents (ARVs), and over 30 individual drugs:

  1. Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
  2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  3. Protease inhibitors (PIs)
  4. Integrase inhibitors (INIs)
  5. Fusion inhibitor
  6. CCR5 antagonist
  7. CD4 T lymphocyte (CD4) post-attachment inhibitor
  8. gp120 attachment inhibitor

There are also two drugs, ritonavir (RTV) and cobicistat (COBI) which can be used as pharmacokinetic (PK) enhancers (or boosters) to improve the PK profiles of PIs and the INI elvitegravir.

Depending on the guidelines being followed, initial treatment generally consists of two nucleoside reverse transcriptase inhibitors along with a third ARV, either an INI, an NNRTI, or a PI with a booster.

References

  • https://www.who.int/news-room/fact-sheets/detail/hiv-aids