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General: Most cases of IRIS resolve within a few weeks with continued HIV treatment. In addition, antibiotics, antifungals or antivirals may be administered to treat OIs, and corticosteroids may be used to suppress the inflammatory process. Highly active antiretroviral therapy (HAART): When HIV reproduces, different strains of the virus emerge, and some are resistant to antiretroviral drugs. Therefore, it is common for healthcare providers to recommend a combination of antiretroviral drugs known as HAART. This strategy, developed by NIAID–support researchers, usually combines drugs from at least two different classes of antiretroviral drugs, and it has been shown to suppress the virus. While these drugs cannot cure HIV infection or AIDS, they can suppress the virus. Currently, the U.S. Food and Drug Administration (FDA) has approved 28 antiretroviral drugs to treat HIV. These drugs fall into three major classes – reverse transcriptase (RT) inhibitors, fusion inhibitors and protease inhibitors. In July 2006, the FDA approved a multi–class combination called Atripla ®. Fusion inhibitors prevent the virus from fusing with the cellular membrane, thus blocking entry into the cell. Only one fusion inhibitor, Fuzeon ®, is FDA–approved. Protease inhibitors (PIs) interfere with the protease enzyme that HIV uses to produce infectious viral particles. They are a class of medication used to treat or prevent viral infections, including HIV and Hepatitis C. PIs prevent viral replication by inhibiting the activity of protease, an enzyme used by the virus to cleave nascent proteins for final assembly of new virons. FDA–approved protease inhibitors include Agenerase ®, Aptivus ®, Crixivan ®, Invirase ®, Kaletra ®, Lexiva ®, Norvir ®, Prezista ®, Reyataz ® and Viracept ®. Reverse transcriptase (RT) inhibitors disrupt the reverse transcription stage in the HIV lifecycle. During this stage, an HIV enzyme, known as reverse transcriptase, converts HIV RNA to HIV DNA. There are two main types of RT inhibitors – non–nucleoside RT inhibitors and nucleoside/nucleotide RT inhibitors. Non–nucleoside RT inhibitors bind to reverse transcriptase, preventing HIV from converting the HIV RNA into HIV DNA. Approved non–nucleoside RT inhibitors include Rescriptor ®, Sustiva ® and Viramune ®. Nucleoside/nucleotide RT inhibitors serve as faulty DNA building blocks, and once they are incorporated into the HIV DNA, the DNA chain cannot be completed. Therefore, the drugs prevent HIV from replicating inside a cell. Approved drugs include Combivir ®, Emtriva ®, Epivir ®, Epzicom ®, Hivid ®, Retrovir ®, Trizivir ®, Truvada ®, Videx EC ®, Videx ®, Viread ®, Zerit ® and Ziagen ®. Corticosteroids: Corticosteroids have been used to suppress inflammation caused by IRIS. However, it is unclear whether corticosteroids are necessary because in most cases, patients get better with continued HIV and OI treatment alone. Antifungals: Antifungals are usually administered intravenously. Amphotericin B (Amphocin ®) and fluconazole (Diflucan ®) are the most common drugs used to treat cryptococcus meningitis. Once the infection has been treated, it is usually recommended that the person continue treatment for life in order to prevent the infection from recurring. Anti–virals: Anti–viral medications (like Ganciclovir ® or Foscarnet ®) are often prescribed to treat cytomegalovirus (CMV). These drugs can be administered orally, intravenously, injected directly into the eye or through an intravitreal implant. Antibiotics: A combination of antibiotics (at least two drugs) is used to treat mycobacterium avium complex (MAC). Usually azithromycin or clarithromycin is used with up to three other drugs. MAC treatment must continue for life in order to prevent the infection from recurring. Commonly prescribed antibiotics include amikacin (Amkin ®), azithromycin (Zithromax ®), ciprofloxacin (Cipro ® or Ciloxan ®), clarithromycin (Biaxin ®), ethambutol (Myambutol ®), rifabutin (Mycobutin ®) and rifampin (Rifampicin ®, Rifadin ®, Rimactane ®). However, rifabutin (Mycobutin ®) should not be used to treat HIV patients who are taking the protease inhibitor saquinavir or the non–nucleoside reverse transcriptase inhibitor delavirdine because there is an increased risk of serious side effects like uveitis (inflammation of the inner eye). Combination antibiotics: HIV patients who have tuberculosis usually receive several different medications. The most common drugs used to treat tuberculosis include isoniazid, rifampin (Rifadin ® or Rimactane ®), ethambutol (Myambutol ®) and pyrazinamide. Cycloserine (Seromycin ®), capreomycin (Capastat ®), aminosalicylic acid and streptomycin sulfate have also been used to treat tuberculosis. Standard tuberculosis treatments last from six to nine months. TMP/SMX: TMP/SMX (Bactrim ® or Septra ®) is the most effective treatment for Pneumocystis jiroveci pneumonia. The drug, which is taken orally, is a combination of two antibiotics – trimethoprim (TMP) and sulfamethoxazole (SMX). The SMX antibiotic is a sulfa drug, which may induce an allergic reaction in some patients. Cutting back from one pill a day to three pills a week has shown to reduce the risk of allergy. Allergic reactions to the drug usually induce a skin rash and sometimes a fever. Allergic reactions can be overcome with a desensitization procedure. Patients start with a very small amount of the drug and take increasing doses until they can tolerate the full dose. Dapsone: Dapsone is a sulfone anti–infective drug that is similar to TMP/SMX. Dapsone is almost as effective against Pneumocystis jiroveci pneumonia as TMP/SMX, and it causes fewer allergic reactions. Dapsone is taken orally. Pentamidine: Pentamidine (NebuPent ®, Pentam ®, Pentacarinat ®) is a drug that is inhaled in an aerosol form to prevent Pneumocystis jiroveci pneumonia. Pentamidine can also be administered intravenously (IV) to treat active Pneumocystis jiroveci pneumonia. Patients receive pentamidine at a health clinic that has a nebulizer. The nebulizer is a machine that produces a very fine mist of the drug. The mist is inhaled directly into the lungs. The procedure takes about 30 to 45 minutes. Atovaquone (Mepron ®): Atovaquone (Mepron ®) is an antibiotic that is used in patients who have mild or moderate cases of Pneumocystis jiroveci pneumonia who cannot take TMP/SMX or pentamidine.
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