Applying National Guidelines on ART - ARVs in South Africa

Authors: Ian M. Sanne, MBBCH, FCP(SA); Brian Gazzard, MA, MD, FRCP
Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA) (More Info)

Last Reviewed: July 8, 2016 (What's New)

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Introduction

The goals of successful antiretroviral therapy are prolonging life, achieving maximal suppression of HIV replication, minimising toxicity, and avoiding resistance. Factors that contribute to meeting these goals include the pharmacologic properties of individual drugs, the combined effect of multiple drugs, strategic decisions about when

The first antiretroviral drug to be discovered in 1986—the NRTI zidovudine—was initially used as monotherapy and significantly reduced the replication of the virus in patients, leading to clinical and immunologic improvements.[Wright 1986] However, its benefits were short-lived when used as monotherapy with resistance developing as early as 6 months. Zidovudine remained an integral part of antiretroviral therapy as other drugs were developed. Dual therapy of zidovudine with didanosine[Delta 1996] or lamivudine[CAESAR 1997] was shown to significantly improve survival and the latter became the most widely used approach during the first decade of HIV treatment until other drug classes became available and triple combination therapy became the standard of care in the mid-1990s.[Hammer 1997; Gulick 1997]

During the course of the 30 years since the identification of HIV infection, more than 20 drugs have been developed that are effective against HIV replication. Figure 1 outlines the steps in the HIV lifecycle, and Figure 2 lists the classes of drugs that work at the various stages. Characteristics of the individual drugs are outlined in later sections of this chapter. Table 1 lists the antiretroviral drugs that have been developed in the various classes and are available in South Africa. Drugs that may be available in the near future are also included.

Figure 1. HIV lifecycle.

Figure 2. HIV lifecycle and classes of drugs that work at each step.

Table 1. Antiretroviral Drugs Available and Soon to Be Available in South Africa

NRTIs

NNRTIs

PIs

INSTIs

Entry Inhibitor

Abacavir

Efavirenz

Atazanavir

Raltegravir

Maraviroc*

Didanosine

Etravirine

Darunavir

Elvitegravir…†

 

Emtricitabine

Nevirapine

Lopinavir/ritonavir

Dolutegravir*

 

Lamivudine

Rilpivirine*

Ritonavir

 

 

Stavudine

 

 

 

 

Tenofovir

 

 

 

 Zidovudine

 

 

 

 

INSTI, integrase strand transfer inhibitor.
*Available in the private sector in South Africa.
Not yet available in South Africa.