Current HIV therapy available in selected government health clinics and hospitals in Malaysia is highly active antiretroviral therapy (HAART). HAART consists of at least three antiretroviral (ARV) drugs to suppress the HIV virus and halt disease progression.

All patients with HIV are recommended to undergo antiretroviral treatment regardless of CD4 counts. This treatment prolongs and improves the quality of life for patients. Adherence to the treatment schedule is crucial. Initially, patients are prescribed first-line HAART. If the virus becomes resistant or if side effects are intolerable, second-line treatment is recommended.

Antiretroviral drugs are classified based on their mechanisms of action against the HIV virus:

• Nucleoside reverse transcriptase inhibitors (NRTIs): Zidovudine (AZT), didanosine buffered or enteric coated (DDI), stavudine (D4T), Lamivudine (3TC), abacavir (ABC), tenofovir (TDF), Emtricitabine (FTC).
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Nevirapine (NVP), Efavirenz (EFV), Etravirine (ETV).
• Protease Inhibitors (PIs): Lopinavir/ritonavir (LPV/r), Saquinavir (SQV), Atazanavir (ATV), Darunavir (DRV), Ritonavir (RTV).
• Integrase inhibitors: Raltegravir.
• CCR5 Antagonist: Maraviroc.
• Fusion inhibitor: Enfuvirtide.

Importance of good compliance to HIV therapy:

Before starting first-line HIV therapy, patients must commit to lifelong treatment. Healthcare providers explain the therapy's benefits and risks, emphasizing the importance of adherence. Regular pill intake at consistent times daily is crucial for viral suppression. Missing doses can lead to treatment failure and drug resistance, necessitating more expensive and side-effect-prone second-line drugs.

Supporting patient compliance to HIV therapy:

After agreeing to therapy, doctors provide counseling on pill administration and integrating medication into daily routines. They outline dosing schedules and stress adherence importance. Patients are encouraged to seek support from friends or family for pill reminders and are provided with contact numbers for assistance.

Side effects of HIV therapy:

HIV medications can cause side effects that may lead to non-compliance. Patients experiencing side effects should promptly consult their treating doctor. Examples include:

• Zidovudine (AZT): Anemia, neutropenia, gastrointestinal intolerance.
• Stavudine (D4T): Lactic acidosis, lipoatrophy/metabolic syndrome, peripheral neuropathy.
• Tenofovir (TDF): Renal toxicity.
• Efavirenz: Central nervous system toxicity, hallucinations, psychosis.
• Nevirapine: Hepatitis, hypersensitivity reactions, Stevens-Johnson syndrome.

Initiating HIV treatment in adults:

Treatment should commence for all HIV patients regardless of CD4 count.

Last Reviewed: 28 August 2020
Writer: Dr. Hasniza bt. Hasim