HIV drug classes
Classes of antiretroviral drugs for HIV:
Antiretroviral therapy is most common medication treatment for HIV. HIV drug classes There are almost 25 kinds of antiretroviral therapies are available to reduce the risks of HIV. They are also used by combining some of these antiretroviral medications in the form of pills. The six classes of antiretroviral drugs are here.
- Nucleoside/ nucleotide reverse transcriptase inhibitors (NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Protease inhibitors
- Fusion inhibitors
- CCR5 antagonists, this is also known as entry inhibitor
- Integrase strand transfer inhibitors
These classes of drugs are applied for the favorable conditions. Healthcare providers will provide these medications for a person living with HIV and this decision will depend on following factors.
- Their T cell count
- The person’s viral load
- Their strain of HIV
- The severity of their cases
- How far the HIV has spread
- Co morbidities ( other chronic health condition)
- Other medications that they may taking to avoid the interaction between HIV drugs and other drugs.
- Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs):
These help to interrupt the life cycle of HIV. As the HIV virus replicate and make copies so these drugs work against it to stop replication of virus. NRTIs are also referred as “nukes”. HIV drug classes Some drugs are also here to prevent the replication of virus. Some of the NRTIs drugs are following.
- Abacavir (Ziagen)
- Emtricitabine (Emtriva)
- Lamivudine (Epivir)
- Tenofovir alafenamide fumarate (Vemlidy)
- Tenofovir disoproxil furmarate (Viread)
- Zidovudine (retrovir)
Combination of two or three NRTIs drugs are following.
- Abacavir, lamivudine and zidovudine (Trizivir)
- Abacavir and lamivudine (Epzicom)
- Emtricitabine and tenofovir alafenamide furmarate (Descovy)
- Emtricitabine and tenofovir disoproxil furmarate (Truvada)
- lamivudine and tenofovir disoproxil furmarate (Cimduo, Temixys)
- lamivudine and zidovudine (Combivir)
Some people may also prescribe with Descovy and Truvada without HIV. These are also the part of pre-exposure prophylaxis (PrEP) regimen.
Rarely used NRTIs:
Some of the NRTIs drugs are rarely used and in 2020 they will discontinue by their manufacture.
- Didanosine (Videx, Videx EC)
- Stavudine (Zerit)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs):
NNRTIs drugs are also work in same way as NRTIs. They both help to stop virus from making copies of it. Some of the NNRTIs or non-nukes drugs are following.
- Doravirine (Pifeltro)
- Efavirenz (sustiva)
- Etravirine (intelence)
- Nevirapine (viramune, viramune XR)
- Rilpivirine (Edurant)
Rarely used NNRTIs:
Delavirdine (Rescriptor) is the NNRTIs which is rarely used and its manufacturer was discontinued in 2018.
- Integrase strand transfer inhibitors (INSTIs):
Integrase is a viral enzyme that HIV uses to infect T cells. It put DNA of HIV into the human DNA. Intregase inhibitors use to inhibit the action of integrase. This is the first inhibitor which is used for people who have recently get HIV virus inside body. This is best as it works well and has fewer side effects.
Integrase inhibitors have following drugs:
- Bictegravir (It is not available as a stand-alone drug, but it is available in combination drug Biktarvy)
- Dolutegravir (Tivicay)
- Elvitegravir (It is also not available as a stand-alone drug, but it is available in combination drugs Genvoya and Stribild)
- Raltegravir (Isentress, Isentress HD)
- Protease inhibitors (PIs):
Basically protease is needed to replicate in the body by HIV. Protease inhibitors (PIs) are worked against it by binding the enzyme protease. Protease is not able to do work. It can’t able to complete the replication process of virus. This also reduces the number of viruses by replication process.
To treat Hepatitis C some PIs are only FDA-approved, but these are not same and used for HIV treatment. PIs drugs which are used for HIV are given below.
- Atazanavir (reyataz)
- Darunavir (prezista)
- Fosamprenavir (Lexiva)
- Lopinavir (it is not available as a stand-alone drug but available with ritonavir in the combination drug Kaletra)
- Ritonavir (Norvir)
- Tipranavir (Aptivus)
PIs drugs are mostly used with cobicistat or ritonavir, the CYP3A inhibitors.
Rarely used PIs:
Some of the PIs drugs are rarely used because of their more side effects.
- Indinavir (Crixivan)
- Nelfinavir (Viracept)
- Saquinavir (Invirase)
- Fusion inhibitors:
HIV requires more T cells to make copies of it. Fusion inhibitors block the entire virus from entering a host T cell. This also prevents them to replicate the virus cells.
In United States, fusion inhibitors are rarely used because many of the other drugs are more effective and better than these. Fusion inhibitor which is currently available is
- Enfuvirtide (Fuzeon)
As HIV disease causes damage or destroys in immune system by replicating its own virus cells. Researchers have searched and studied on the way that can help to prevent the replication of viruses. In clinical trials immune based treatments have been proved as beneficial. To treat HIV the first immune based therapy received by FDA-approval in 2018.
- Ibalizumab-uiyk (Trogarzo)
This class of drugs also known as post-attachment inhibitors as it helps to stop HIV virus from entering in the immune cells. Medication treatments should be used with other antiretroviral. Optimized background therapy or optimized background regimen may also use there.
Chemokine co receptor antagonists (CCR5 antagonists):
Chemokine coreceptor antagonists or CCR5 antagonists help to block HIV from entering cells to stop the replication of it. In United States, Chemokine co receptor antagonists are rarely used because many of other effective drugs are available that are more effective. Special testing is required for this medication. Only one Chemokine co receptor antagonists (CCR5 antagonists) is currently available for use.
- Maraviroc (Selzentry)
- Entry inhibitor:
Entry inhibitors are included many of other inhibitors such as fusion inhibitors, post-attachment inhibitors and CCR5 antagonists (which are explained in previous points). Inhibitors are indicated as blocking sites for anything. Here all these inhibitors are used to block the entry of virus in the healthy T cells. These drugs are also rarely used.
Entry inhibitors drugs are following.
- Enfuvirtide (Fuzeon)
- Ibalizumab-uiyk (Trogarzo)
- Maraviroc (selzentry)