WHO guidelines recommend initiation of antiretroviral therapy (ART) regardless of CD4 count for all people living with HIV, including people who use drugs. ART should be started as soon as possible after the diagnosis.
WHO guidelines recommend initiation of antiretroviral therapy (ART) regardless of CD4 count for all people living with HIV, including people who use drugs. ART should be started as soon as possible after the diagnosis.
There are more than 30 antiretroviral drugs belonging to six different drug classes. Some HIV medicines are available in combination, meaning that two or more different HIV medicines are combined in one pill and with some combinations, only one pill per day is needed but such pills are not yet available in all countries. It is very important that medicines are taken regularly every day. Poor adherence to an HIV treatment regimen increases the risk of drug resistance and treatment failure.
Antiretroviral drugs (ARVs) used to treat HIV are grouped by how they interfere with steps in the replication cycle of HIV. Fusion inhibitors block the virus from binding to the target cell. Nucleoside analogs prevent the transcription of virus RNA to DNA. Integrase inhibitors inhibit virus DNA from integrating into to the cell genome and protease inhibitors prevent cells from making new virus particles.
HIV treatment with ARVs do not cure people of HIV. They suppress the replication of the virus to an undetectable level, but cannot remove viruses that have already integrated into a cell’s genome. If the treatment is stopped, the infected cells start producing new virus particles again and there is also risk that viruses resistant to the ARVs used will be produced. This means that the ARV that had been used may no longer be effective in treating HIV in that person. It is very important that ARVs are taken every day for the rest of the person’s life. Treatment providers should be aware of other medicines as well as street drugs that people with HIV are taking when ARV is initiated and new drugs that are added during continuing treatment.
According to the WHO guidance, ARV drugs have the potential to either decrease or increase the bioavailability of steroid hormones in hormonal contraceptives. Limited data suggest potential drug interactions between contraceptive hormones and many ARV drugs (especially some non-nucleoside reverse transcriptase inhibitors (NNRTIs) and ritonavir (RTV)-boosted PIs). These interactions may alter the safety and effectiveness of both the hormonal contraceptive and the ARV drug. However, current WHO contraception guidelines conclude that none of the drug interactions between currently recommended ARVs for treatment and for PrEP, on one hand, and, on the other, hormonal contraceptives are significant enough to prevent their use together. If women receiving ART decide to initiate or continue using hormonal contraceptives, consistent use of condoms is recommended both to prevent HIV transmission and to compensate for any possible reduction in the effectiveness of the hormonal contraception.
WHO recommends methadone and buprenorphine to treat opioid dependence. Co-administering efavirenz (EFV) decreases methadone concentrations. This could subsequently cause withdrawal symptoms and increase the risk of relapse to opioid use. People receiving methadone and EFV should be monitored closely, and those experiencing opioid withdrawal may need to adjust their methadone dose. The limited evidence suggests interactions between ARVs and illicit drugs.
