ARV Therapy Basics in the Context of Family Planning

ARV Therapy Overview

• Inhibits replication of the virus

• Slows disease progression; improves quality of life

• Different drugs attack virus at different stages of replication

• Combine three drugs into HAART “cocktail” for best results

decrease decrease viral loadviral load

improveimproveimmuneimmune functionfunction

Classes of ARV Drugs

• NRTIs – Nucleoside reverse transcriptase inhibitors

• NtRTIs – Nucleotide reverse transcriptase inhibitors

• NNRTIs – Non-nucleoside reverse transcriptase inhibitors

• PIs – Protease inhibitors

• Entry inhibitors (other new classes under development)

HAART Therapy Regimens

=+NR

TI

NNRTINNRTI

NR

TI

PI

ORStandard HAART

Regimen

ARV therapy is complex and should ARV therapy is complex and should only be offered by trained providers.only be offered by trained providers.

Source: WHO, 2006.

Use of ARV Drugs for HIV Prophylaxis

• Prevent mother-to-child transmission (PMTCT)– drug regimen depends on availability, cost,

resistance, possible side effects– reduces vertical transmission by 34% to 50%

• Postexposure prophylaxis (PEP) – start as soon as possible; continue 4 weeks– multidrug therapy is more effective

• Other uses under study

Source: Dabis, 2000; CDC, 2005.

Why ARV Clients Benefit from Contraception

• Reduce stress related to unintended pregnancy

• Avoid complicated pregnancy (ARVs can aggravate anemia and insulin resistance, which are common in pregnancy)

• Have access to wider range of ARV drugs if not pregnant or at risk of pregnancy (some ARVs have potential harmful effects on fetus)

EFZ should not be given to women of childbearing potential EFZ should not be given to women of childbearing potential unless effective contraception can be assured. unless effective contraception can be assured. – WHO, 2004– WHO, 2004

Source: Shelton, 2004; Powderly, 2002; WHO, 2004.