1. This training program is funded through an unrestricted educational grant from Janssen Therapeutics.

2. ART 101
Successful HIV treatment usually consists of at least three drugs from two different “classes” of ARV drugs
There are now six classes of ARV drugs:
NRTIs (nucleoside reverse trascriptase inhibitors)
NNRTIs (non-nucleoside reverse trascriptase inhibitors)
PIs (protease inhibitors)
Integrase inhibitors
CCR5 antagonists
Fusion inhibitors
Each works somewhat differently at stopping HIV from multiplying

3. ART goals Improving your quality of life
Extending, enhancing your life
Reducing your chance of developing OIs (opportunistic infections)
Restoring and/or preserving your immune system
Maximizing and sustaining a suppression in the amount of HIV in your blood (your “viral load”)

4. Tools to achieve ART goals
Selection of potent ARV regimen
Preservation of future treatment options
Rational sequencing of ARV regimens
Maximizing adherence
Use of resistance testing

5. Defining ART success
Within about two weeks after starting ART, your viral load will decrease dramatically
Within two to six months, you will probably be told that your HIV is “undetectable”
Undetectable means that even though you are still HIV positive, your viral load is so low that tests are not sensitive enough to detect it in your blood

6. Defining ART success
Your CD4 count will increase, and your immune system can recover and do its job
With more CD4 cells, there is less of a chance of developing an OI, such as thrush
If you take all your ARV drugs on time, your chances of remaining undetectable are EXCELLENT

7. What if I am detectable?
If you are on your third, fourth, or fifth ARV regimen, reaching undetectable status is sometimes difficult
Fortunately, many recent studies show there is a benefit to keeping your viral load as low as you can, even if it is detectable

8. Current ARV medications
NRTIs
abacavir (ABC)
didanosine (ddI)
emtricitabine (FTC)
lamivudine (3TC)
stavudine (d4T)
tenofovir (TDF)
zidovudine (ZDV)
NNRTIs
delavirdine (DLV)
efavirenz (EFV)
etravirine (ETR)
nevirapine (NVP)
rilpivirine (RPV)
PIs
atazanavir (ATV)
darunavir (DRV)
fosamprenavir (FPV)
indinavir (IDV)
lopinavir (LPV/r)
nelfinavir (NFV)
ritonavir (RTV)
saquinavir (SQV)
tipranavir (TPV)
PK Enhancers
cobicistat (COBI)
Integrase Inhibitors
raltegravir (RAL)
elvitegravir (EVG)
Fusion Inhibitor
enfuvirtide (ENF, T-20)
CCR5 Antagonist
maraviroc (MVC)

9. Constructing ARV regimens
25 individual ARV drugs and 9 co-formulated ARV drugs are currently FDA-approved in the United States
Theoretically thousands of ARV regimens can be constructed/prescribed
ART success can be improved by:
Constructing an appropriate ARV regimen
Preserving future treatment options
Maximizing adherence
Testing for drug resistance

10. FDcs and strs
Fixed-dose combination (FDC): Two or more drugs contained in a single doseage form, such as a capsule or tablet
Single-tablet regimen (STR): An FDC capsule or tablet containing all drugs that comprise an ARV regimen
By reducing the number of pills a person takes each day, FDC drugs can help improve adherence to HIV treatment
Currently FDA-approved FDCs, including STRs:
NRTIs:
PIs:
STRs:
Combivir (3TC + ZDV)
Kaletra (LPV/RTV)
Atripla (EFV + FTC + TDF)
Epzicom (ABC + 3TC)
Complera (RPV + FTC + TDF)
Trizivir (ABC + 3TC + ZDV)
Stribild  (EVG/COBI + FTC + TDF)
Truvada (FTC + TDF)