Current+AIDS+Treatments

Nathaniel Gorman

**Current AIDS Treatments**
IV has proven to be an immensely difficult to treat viral infection for a few key reasons. First is the unique structure of the virus. While most viruses are comprised of deoxyribonucleic acids (DNA) which are used for the infection and replication, HIV is composed of ribonucleic acids (RNA). This distinction classifies HIV as a retrovirus. Retroviruses are unique due to their usage of a special enzyme, reverse transcriptase, to copy their genetic data into the infected CD4 (T-Cell immunity type) host cell. In addition, because a virus uses a cell's own structures in order to reproduce infected cells, development of an anti-virus to destroy HIV but leave healthy cells undamaged has proven very difficult. Finally, HIV has been observed to infect cells and then become dormant for seemingly arbitrary amounts of time adding to the mystery of how HIV functions and how to develop a means to interrupt its replication ("AIDS Therapies and Vaccines”, 2011). It is important to note that the HIV/ AIDS disease itself is not deadly; however, because the disease acts to inhibit and eventually disable the immune system, even the weakest common cold can be deadly for someone suffering from AIDS. As a result there are generally two classifications of drugs used to treat HIV/ AIDS. The first category seeks to disable the replication of the virus and the second seeks to prevent infection from opportunistic diseases the body would ordinarily not have an issue fighting ("What Treatments Are Available For HIV and AIDS?", 2002).
 * T****h****e Diffic****ulty of Treating HIV (Human Immunodeficiency Virus) and resulting AIDS (Acquired Immune Deficiency Syndrome)** [[image:CMN368_Wiki_2.jpg align="right" caption="HIV Virus"]]

**HIV Suppression Treatment** HIV Suppression drugs seek to either prevent the virus from infecting healthy cells or by interrupting the reverse transcriptase thereby preventing reproduction. In nearly all cases it has been observed that a "cocktail" of a variety of these drugs is noticeably more effective than any one alone. As a result many of these categories, or even various drugs within each category, are used in unison. In general there are four segments for these types of medications:

**Nucleoside Analog Reverse Transcriptase Inhibitors (NRTIs) -** In order for the single genome RNA within HIV to reproduce it must reverse transcriptase thereby interrupting the ordinary replication of a cell's dual genome DNA. The HIV RNA effectively rewrites the cell's coding to now produce HIV infected cells. NRTIs seek to halt this process by providing faulty nucleotides used to convert the HIV's RNA to DNA. Because these necessary building blocks for producing new DNA from the HIV's RNA are unusable by the virus, the infection of the cell is blocked and the cell's DNA remains healthy ("Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)", 2008). Some commonly used NRTIs are AZT (generically Zidovudine), DDC (Zalcitabine), DDI (Didanosine), D4T (Stavudine), and 3TC (Lamivudine). The image to the right DDC (left), DDI (right), and AZT (front) ("What Treatments Are Available For HIV and AIDS?", 2002). **Non- nucleoside Reverse Transcriptase Inhibitors (NNRTIs) -** In general, this form of medication works in the same way that the NRTIs work, they seek to interrupt the process enzyme reverse transcriptase from converting the infectious RNA into the healthy cell's DNA. Where this type of drug varies, and is implied by the "non- nucleoside" nomenclature, is how it halts the RNA to DNA conversion. NNRTIs inhibit HIV replication by binding themselves to the reverse transcriptase enzyme preventing it from functioning as intended. This contrasts with the NRTIs in that the enzyme itself is attacked without the use of falsified nucleotides ("Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)", 2010). Some of the common types of medications of this type are Delavirdine, Nevirapine, and Efavirenz ("What Treatments Are Available For HIV and AIDS?", 2002). **Protease Inhibitors -** These types of medications seek to interrupt a later stage of the HIV replication after the RNA has infected and the cell is reproducing HIV DNA. HIV protease is a protein cutting enzyme required to activate fully functional HIV cells. This enzyme is compromised by Protease Inhibitors meaning the newly produces HIV infected cells are no longer capable of infecting further cells ("Protease Inhibitors (PIs)", 2008). Common types of these medications are Saquinavir, Indinavir, Ritonavir, Nelfinavir, and Amprenavir ("What Treatments Are Available For HIV and AIDS?", 2002). **Fusion Inhibitors -** These types of drugs work in a significantly different way than the other three previously mentioned categories of medications. As opposed to attempting to block further infection by damaging already infected HIV cells, this medication modifies healthy cell's outer protein composition to make it incompatible with the proteins on the outside of the HIV. As a result, the HIV is unable to penetrate the cell and thus cannot infect the T-Cells. There are only two FDA approved medications available today, Fuzeon (Enfuvirtide) and Selzentry (Maraviroc).

**Treatment of AIDS Related Conditions** There are a variety of common afflictions found consistently in AIDS patients. These diseases are especially problematic given the inherent weakness of the individual’s immune system. The following antibiotics and anti- viral medications are used to treat various conditions common to AIDS patients. While virtually any infectious disease is a risk for someone with AIDS, the following are most common:

**Antibiotic Treatment –** Pneumonia, yeast infections (in females), and Pelvic Inflammatory Disease (PID) are combated with various forms of antibiotics ranging from TMP/ SMX, Fluconazole, and generic intravenous antibiotics respectively. The treatment of yeast infections specifically with Fluconazole is important because no resistance to the drug is developed with use. **Anti-Viral Treatment –** Severe skin ulcers are a common skin condition for AIDS patients which are common fought with the anti-viral medication, Acyclovir. **Cancer Treatment –** For AIDS patients with cancer (specifically Kaposi’s Sarcoma, shown at right, is common and develops quickly ["Kaposi's Sarcoma: MedlinePlus", 2011]), standard cancer treatments like radiation and chemotherapy are used. In addition, the injection of alpha interferon, a genetically engineered, naturally occurring protein, is sometimes used to halt the spread of cancer ("What Treatments Are Available For HIV and AIDS?", 2002).

**Problems with Current Treatments** The primary issues associated with the currently defined AIDS treatments pertain to the side effects caused by the aforementioned medications as well as the significant cost associated with providing these medications. There is a wide array of side effects from the strong HIV/ AIDS medications including, but not limited to, headaches, hypertension, fatigue, anemia, digestive problems, gas and bloating, diarrhea, lipodystrophy, skin problems, nueorpathy, mitochondrial toxicity, and bone problems ("AIDS Information, Education, Action, Awareness | Side Effects", 2011). The high cost is greatly offset by insurance and government grants. A lack of this kind of funding in third-world countries is seriously impeding the battle against the HIV epidemic ("What Treatments Are Available For HIV and AIDS?", 2002).

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