Combination anti-HIV therapy is now the standard of care for people with HIV. There are now 14 anti-HIV drugs available by prescription. These anti-HIV drugs fall into three categories: Nucleoside analogs, which include AZT (Retrovir), ddI (Videx), ddC (HIVID), d4T (Zerit), 3TC (Epivir) and abacavir (Ziagen); Protease inhibitors, which include amprenavir (Agenerase), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Fortovase) and ritonavir (Norvir); Non-nucleoside reverse transcriptase inhibitors or NNRTIs, which include nevirapine (Viramune), delavirdine (Rescriptor) and efavirenz (Sustiva).

Studies clearly show that three-drug combinations of these anti-HIV drugs are much more effective than one drug used alone or two-drug combinations in preventing disease progression and death. A study of a triple drug combination using a protease inhibitor with two nucleoside analog anti-HIV drugs showed that the triple combination could greatly reduce disease progression and deaths in people with AIDS. The name now commonly given to combinations of anti-HIV drugs is HAART (Highly Active Anti-Retroviral Therapy).

A new test for measuring how well anti-HIV drugs are working is also now available. The test is called the viral load test, and measures the amount of HIV in the blood. Researchers are finding that the level of HIV in the blood is linked to a person's risk of getting sick. A study has shown that using drug treatments to lower the level of HIV can reduce the chances that a person will get sick.

New recommendations from the National Institutes for Health and the Public Health Service state that the goal of anti-HIV treatment is to keep the level of HIV in the body as low as possible, for as long as possible. Currently available viral load tests cannot find less than 50 copies of HIV in the bloodstream. Any number less than this is known as "undetectable." This does not mean that there is no HIV in the blood, just that there is too little for the test to be able to find. Keeping the viral load below what the test can measure is thought to be the ideal goal of anti-HIV treatment.

The best combination of anti-HIV treatments to use to try and achieve this goal is not yet known for certain. Combination anti-HIV treatment should be carefully chosen based on several factors:

• Which anti-HIV treatments have I already taken?
• Which combination has the best chance of reducing the amount of HIV in my body for the longest time?
• What are my options if this combination stops working?
• What are the possible side effects of the drug combination?
• How many pills will I need to take?
• What symptoms do I have now?

HIV can get resistant to the effects of anti-HIV drugs that you have already taken. To get the best anti-HIV effect from a triple combination, it should include at least two new drugs that you haven't taken before. Ideally, all three drugs would be new. For someone that's taken a lot of anti-HIV drugs before, it's not always easy to find new anti-HIV drugs to take. In this situation, a combination of one new drug with two others that the person had not taken for a long time may be the best option. It is also a good idea to check to see if any newer experimental drugs may be available through compassionate use or expanded access programs. Call The Network at (800) 734-7104 for the latest information on open compassionate use and expanded access programs.

The best time to start combination therapy is not yet known. The new viral load tests may be helpful, as studies have shown the risk of disease progression is higher when the viral load is above 10,000. Most trials of anti-HIV drugs have also found benefits to treatment when the T4 cell count has dropped below 500. Because medication to prevent an opportunistic infection called PCP is needed when the T4 cell count goes below 200, anti-HIV treatment is usually considered before the T4 cell count gets this low.

All anti-HIV drugs can cause side effects. The Network has individual fact sheets on each of the avaiable anti-HIV drugs. Call us for free copies. You can also ask for the latest results from studies of combination anti-HIV therapies.

The Simple Facts Project is a program of the AIDS Treatment Data Network (The Network). This information does not intend to promote or endorse any specific treatment for any health related condition.