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- General: In order to control, MAC, the immune system must be restored. Therefore, all patients who are not taking antiretroviral therapy (ART) should begin treatment. In general, MAC infection is treated with two or three antimicrobials for life in order to prevent the infection from recurring. HIV patients who have DMAC infections usually receive a combination of newer macrolide antibiotics (clarithromycin, azithromycin) with ethambutol and rifabutin.
- Antimicrobials: The U.S. Centers for Disease Control and Prevention (CDC) recommends the following two drug regimens: 500mg of the macrolide antibiotic clarithromycin (Biaxin ®) twice daily, plus 15mg/kg of ethambutol (Myambutol ®) once daily, or 500–600mg of azithromycin (Zithromax ®) once daily, plus 15mg/kg of ethambutol (Myambutol ®) once daily. Several studies suggest that azithromycin can effectively treat 55–60% of MAC infections. Higher doses of clarithromycin (1000mg or more) are associated with higher mortality rates.
- Other antimicrobials commonly prescribed include rifabutin (Mycobutin ®), levofloxacin (Levaquin ®) and amikacin (Amikin ®).
- Patients who have MAC will continue treatment for life in order to prevent the infection from recurring.
- 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 infected individual. 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 interfere with the protease enzyme that HIV uses to produce infectious viral particles. They are a class of medication used to treat or prevent infection by viruses, including HIV and Hepatitis C. PIs prevent viral replication by inhibiting the activity of protease, an enzyme used by the viruses 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 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 reverse transcriptase 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 antiretrovirals include Combivir ®, Emtriva ®, Epivir ®, Epzicom ®, Hivid ®, Retrovir ®, Trizivir ®, Truvada ®, Videx EC ®, Videx ®, Viread ®, Zerit ® and Ziagen ®.
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