The NNRTI class includes nevirapine (NVP), efavirenz (EFV), rilpivirine (RPV), etravirine (ETR) and doravirine (DOR). NNRTIs bind directly to the reverse transcriptase enzyme and block the RNA-dependent and DNA-dependent polymerase activities by causing a disruption of the enzyme’s catalytic site. This reduces enzyme activity and diminishes viral replication. Importantly NNRTIs are not active against HIV-2 …
HIV protease inhibitors (PIs) inhibit HIV-1 and HIV-2 proteases and prevent cleavage of the gag-pol polyprotein during maturation of the newly formed viral particle. This results in the production of immature, non-infectious virus. There are currently seven licensed PIs: atazanavir (ATV), darunavir (DRV), fosamprenavir (FOS), lopinavir (coformulated with ritonavir [LPV/r]), ritonavir (RTV), saquinavir (SQV) and …
Integrase strand transfer inhibitors (INSTIs) prevent the integration of HIV DNA into the nucleus of the host cell. Elvitegravir is only available as part of an FDC tablet with tenofovir or emtricitabine and cobicistat, unlike raltegravir and dolutegravir which are available as individual medications. Dolutegravir is also available co-formulated with abacavir and lamivudine or rilpivirine …
Two antiretroviral drugs have been developed that act as entry inhibitors, forming two separate classes; the fusion inhibitor enfuvirtide and the CCR5-receptor antagonist maraviroc. Fusion inhibitors Enfuvirtide (also known as T-20) is a synthetic 36-amino acid peptide analogue. It binds to HIV-1 gp41, interrupting the fusion reaction and preventing the virus from infecting the host cell. Enfuvirtide, …
New antiretroviral agents in the existing classes are being developed with the aim of producing drugs with more favourable toxicity profiles and activity against drug-resistant HIV. These include a new CCR5 inhibitor cenicriviroc (Phase III) that also has activity blocking CCR2, thereby dampening inflammation. There is also a monoclonal antibody directed against CCR5 (PRO 140) …
Antiretroviral drug regimens that should not be offered at any time are shown in Table 8. Table 8. Antiretroviral drug regimens that should not be offered at any time (see the DHHS guidelines for exceptions[2]) Antiretroviral drug regimen Rationale Monotherapy with NRTIs Inferior virological activity plus rapid development of resistance Dual-NRTI regimens Inferior virological activity …
Australasian Society of HIV Medicine. Antiretroviral Guidelines: US DHSS Guidelines with Australian Commentary 2019 [Available from: http://arv.ashm.org.au/. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Last updated 10 July 2019. Available at: https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/0 INSIGHT START Study Group. Initiation of Antiretroviral Therapy in Early …
Australian Clinical Guidelines on HTLV-1 Now Available The Australian Clinical Guidelines on HTLV-1 for Aboriginal Primary Health Care Settings provide a comprehensive, culturally safe, and evidence-based approach to the prevention, testing, diagnosis, management, and care of Human T-lymphotropic virus subtype 1 (HTLV-1). Read the guidelines HTLV-1 and -2 infection have been described in people with …
I am indebted to Dr Graham Nielsen for commenting on and proof reading the manuscript.
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