To reduce the risk of disease progression and to prevent the transmission of the virus to others, antiretroviral therapy (ART) is recommended for all patients with HIV infection. The Food and Drug Administration has approved more than 25 antiretroviral drugs in 6 mechanistic classes (Table 4).25,26 Recommended regimens are those with durable virologic efficacy, favorable tolerability and toxicity profiles, and ease of use (including some newer combinations).
|Class||Drugs||Mechanisms of Action|
|CCR5 antagonists||maravoric||Blocks CCR5, one of two major co-receptors, used by HIV-1 to attach to host cells|
|Fusion inhibitors||enfuvirtide||An anti-HIV peptide structurally similar to a segment of the HIV protein (gp41) - blocks membrane fusion|
|Nucleoside reverse transcriptase inhibitors (NRTIs)||abacavir
tenofovir (the only nucleotide RTI)
|Mimic deoxyribonucleoside triphosphate, the natural substrate for reverse transcriptase – they become incorporated into the growing DNA chain, terminate elongation and decrease or prevent HIV replication|
|Non-nucleoside reverse transcriptase inhibitors (NNRTIs)||efavirenz
|Bind near the catalytic site of reverse transcriptase and inhibit a crucial step in the transcription of the RNA genome into a double-stranded retroviral DNA|
|Protease inhibitors (PIs)||atazanavir
|Prevent cleavage of viral proteins during assembly and maturation – a process essential for the newly formed virus to become infectious|
|Integrase strand transfer (InST) inhibitors||raltegravir||Blocks HIV-1 integrase – prevents viral DNA from integrating with host cell DNA|
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