HIV Treatment in Singapore: Human immunodeficiency virus (HIV) is treated with a combination of medications taken daily, to suppress the virus from multiplying, called antiretroviral therapy (ART). ART cannot cure HIV, but allows people living with HIV (PLWH) to live longer and healthier.
There are 3 types of HIV treatment:
Classes of HIV medication:
|Entry inhibitors||Tradename||Dose||Freq.||FDA Approval|
|maraviroc (MVC)||Selzentry||600mg||bd||2007 Aug|
|enfuvirtide (T-20)||Fuzeon||90mg||bd||2003 Mar|
|Trade name||Dose||Freq.||FDA App.|
|NRTI / pyrimidine / thymidine|
|azidothymidine (AZT) / zidovudine (ZDV)||Retrovir||300mg||bd||1987 Mar||300mg||250mg|
|stavudine (d4T)||Zerit||40mg||bd||1994 Jun||30mg / 40mg|
|NRTI / pyrimidine / cytidine|
|lamivudine (3TC)||Epivir||300mg||od||1995 Nov||150mg||300mg||150mg||150mg|
|emtricitabine (FTC)||Emtriva||200mg||od||2003 Jul||200mg||200mg||200mg||200mg||200mg|
|NRTI / purine / adenosine|
|didanosine (ddI)||Videx||400mg||od||1991 Oct|
|tenofovir disoproxil (TDF)||Viread||300mg||od||2001 Oct||300mg||300mg||300mg|
|tenofovir alafenamide (TAF)||10mg||25mg|
|NRTI / purine / guanosine|
|abacavir (ABC)||Ziagen||300mg||bd||1998 Dec||300mg||600mg|
|NRTI combinations:||Truvada||Combivir (ZDV/3TC)||Epzicom
|FDA Approval:||2004 Aug||1997 Sep||2004 Aug||2016 Apr|
|nevirapine (NVP)||Viramune||200mg||bd||1996 Jun||200mg||200mg|
|delavirdine (DLV)||Rescriptor||400mg||tds||1997 Apr|
|efavirenz (EFV)||Sustiva||600mg||od||1998 Sep||600mg|
|etravirine (ETR)||Intelence||200mg||bd||2008 Jan|
|rilpivirine (RPV)||Edurant||25mg||od||2011 May||25mg||25mg|
|raltegravir (RAL)||Isentress||400mg||bd||2007 Oct|
|dolutegravir (DTG)||Tivicay||50mg||od||2013 Aug||50mg|
|elvitegravir (EVG)||Vitekta||150mg||od||2014 Sep||150mg||150mg|
|cobicistat (COBI)||Tybost||150mg||od||2014 Sep||150mg||150mg|
|Complete regimens:||Atripla||Complera||Stribild (QUAD)||Trizivir||Triumeq||Genvoya||Odefsey||Z250||S30 / S40|
|FDA Approval:||2006 Jul||2011 Aug||2012 Aug||2000 Nov||2014 Aug||2015 Nov||2016 Mar|
|PIs (protease inhibitors)|
|saquinavir (SQV)||Invirase||1,000mg||bd||1995 Dec|
|ritonavir (RTV)||Norvir||600mg||bd||1996 Mar||50mg|
|indinavir (IDV)||Crixivan||800mg||tds||1996 Mar|
|nelfinavir (NFV)||Viracept||1,250mg||bd||1997 Mar|
|lopinavir (LPV)||2000 Sep||200mg|
|atazanavir (ATV)||Reyataz||300mg||od||2003 Jun||300mg|
|fosamprenavir (FPV)||Lexiva||1,400mg||bd||2003 Oct|
|tipranavir (TPV)||Aptivus||500mg||bd||2005 Jun|
|darunavir (DRV)||Prezista||800mg||od||2006 Jun||800mg|
|cobicistat (COBI)||Tybost||150mg||od||2014 Sep||150mg||150mg|
|Boosted PIs:||Kaletra (LPV/r)||Evotaz||Prezcobix|
|FDA Approval:||2000 Sep||2015 Jan||2015 Jan|
Each HIV-infected patient entering into care should have a complete medical history, physical examination, and laboratory evaluation and should be counselled regarding the implications of HIV infection. The goals of the initial evaluation are to confirm the presence of HIV infection, obtain appropriate baseline historical and laboratory data, ensure patient understanding about HIV infection and its transmission, and initiate care as recommended by established guidelines. Baseline information can then be used to define management goals and plans.
The following laboratory tests performed during initial patient visits can be used to stage HIV disease and to assist in the selection of antiretroviral (ARV) drug regimens:
Newly diagnosed HIV-infected persons should receive psychosocial evaluation including ascertainment of behavioral factors indicating risk for transmitting HIV. They may require referral for specific behavioural intervention (e.g; a substance abuse program), mental health disorders (e.g; depression), or emotional distress. They might require assistance with securing and maintaining employment and housing as well as medical insurance status and adequacy of coverage. Women should be counselled or appropriately referred regarding reproductive choices and contraceptive options.
More than 20 approved ARV drugs in 6 mechanistic classes are available to design combination regimens. These 6 classes include the nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors (FIs), CCR5 antagonists, and integrase strand transfer inhibitors (INSTIs).
A combination ART regimen generally consists of two NRTIs + one active drug from one of the following classes: NNRTI, PI (generally boosted with RTV), INSTI, or a CCR5 antagonist. Selection of a regimen should be individualized based on virologic efficacy, toxicity, pill burden, dosing frequency, drug-drug interaction potential, resistance testing results, and the patient’s comorbid conditions.
Choose one drug from columns A, B and C.
* Coformulated as Atripla (licensed for virologically suppressed patients only).
^ Coformulated as Truvada.
+ Coformulated as Combivir
** Coformulated as Kivexa
^^ Only when CD4<250 cells/μL in female patients and <400 cells/μL in male patients
++ Where there are established cardiovascular disease risk factors and a PI is required.
Initiating Antiretroviral Therapy in Treatment-Naive Patients
There have been recent changes to recommendations on initiation of ART in treatment-naive patients. This is due to increasing evidence showing the harmful impact of ongoing HIV replication on AIDS and non-AIDS disease progression. In addition, the updated recommendations reflect emerging data showing the benefit of effective ART in preventing secondary transmission of HIV. The following recommendations have been accessed from: http://www.aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf . as of September 2012.
ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count:
Regardless of CD4 count, initiation of ART is strongly recommended for individuals with the following conditions:
Please refer to the latest treatment guidelines before initiating treatment.
Proper management of HIV infection requires medical therapy, which for many patients should be coupled with behavioural and psychosocial services. Comprehensive HIV treatment services are available at infectious disease clinics, and patients should be referred there upon diagnosis of HIV infection.