New age ARVs are the game-changers in the battle against AIDS

Flash back to 1981, the first case of AIDS was declared by the Center of Disease Control (CDC) in the United States.  AIDS then spread, taking the form of pandemic, leaving lives shattered and people living with HIV (PLHIV) were left waiting for death with an incurable disease. years later in 1990s, the world got saw a ray of hope in form of highly active antri retroviral therapy (HAART). Since then the science has taken a giant leap ahead.  Did you know that in the US in 2006, the life expectancy at 20 with HIV through ARV support stood at another 52 years? This is from 27 years in 1996. Living in seventies is almost as good as normal life expectancy. The goal of Anti Retro Viral Therapy (ART) is to control the viremia load in the infected individual to reduce morbidity and raise life expectancy. 

Further progress has been made on aspects related to when to start ART and in what combinations. The Department of Health and Human Services (DHSS) of the US recommends initiation of ART early, with a CD4 count in excess of 500. Some other agencies recommend going on to ARTs with a CD4 count between 350 and 400. The clinical implications of early and delayed start of ART have been studied in great detail. The findings are in the favor of early start, also because of the clear treatment is prevention evidence. 

There are a number of combination regimens exist with the available ART choices. Mostly, a combination of Nucleoside Reverse Transcriptase Inhibitors (NRTI) and Non Nucleoside Reverse Transcriptase Inhibitors (NNRTI) are used. Currently, ART is used for providing the life saving support to people living with HIV. But, the preventive use of ART is significant too including in Preventing Mother to Child Transmission (PTMCT), which has been a great success story with children coming into life HIV free. 

The other preventive ways of using ART is treating discordant couple, Pre and Post Exposure Prophylaxis and use of microbicides (microbicides are still under research and not yet available). More exciting work on ART science is in progress. There are a number of new agents in the pipeline including cobicistat, Integrase Inhibitors and CD4 Attachment inhibitors. The future focus of therapy is going to be on a one pill once daily regimen. Long acting ARVs are also researched and tried, with an extended half life. These further developments are bound to improve life quality further and will further increase life expectancy. 

31 years into the science of HIV, today we have about 26 ARVs from 6 classes. They are currently available to about 8.75 million people worldwide, are extremely effective in treatment and prevention and their coverage has been successfully scaled up through a successful collaboration between medical fraternity, academia, Governments and civil society. 

UNAIDS has 15/15 target for ART.  15 million on ART by 2015, worldwide. In the road to zero new infections and battle against AIDS, ART is one of the most critical aspects.    

Prakash Tyagi - CNS
(The author leads 'GRAVIS' and writes extensively on HIV related issues)

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