Anti-retroviral Drugs (ARV)

Antiretroviral therapy is a combination of drugs used to suppress the multiplication of HIV in the body, thereby allowing the body time to repair the immune system. In Botswana, we offer HAART (highly active antiretroviral treatment), which is a combination of three or more ARV drugs. ARV therapy is not a cure for HIV; therefore, it is important for someone to take it in the right way, at the right time for the rest of his/her life, in order to benefit fully from the drugs. This is called good adherence and is described below. When ARV therapy is taken correctly, most patients become healthier and even return to full productivity. Without ARV therapy, chances are very high that HIV-positive people will develop AIDS and die.

ARV drug types are named according to how they act to interrupt the HIV life cycle, thereby helping to reduce viral load levels. There are four types of anti-retroviral drugs used in Botswana. These are:

• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)


• Nucleoside Reverse Transcriptase Inhibitors (NRTI)


• Protease Inhibitors (PI)


• Intergrase Inhibitors

In Botswana, certain treatment combinations have been put into lines. This is to ensure more options in the event of treatment (virologic) failure. The first line is usually very easy to take, has fewer side effects and is designed for those who have never before been on treatment. In addition, certain ARV drugs have been reserved and require HIV specialist consultation before they can be prescribed - this contributes to the provision of more treatment options.

Remember: ARV therapy is not a cure for HIV/AIDS.

In order to be eligible for HAART (ARV therapy), it is important that one be tested and found to be HIV-positive. In addition, the following criteria apply in Botswana:

• Eligibility Criteria – HIV-Positive adolescent or adult (either one of the following):
  
  
  
  • WHO clinical stage 3 or 4, (advanced or severe disease; ranging from persistent diarrhoea, >10% unexplained weight loss to KS, PCP, CMV, cryptococcal meningitis)
  
  
  • CD4 cell count of 350 cells/uL or below
     


• Eligibility Criteria – HIV-Positive Child (either one of the following):
  
  
  
  • Age <1 year, regardless of clinical or immunologic status
  
  
  • WHO clinical stage 3 or 4
  
  
  • “Advanced” or “Severe” immune suppression, as defined by age-related CD4%/count, according to WHO criteria (age <1, <25% or <1500 cells/uL; age 12 -35 mths, <20% or <750; age 36 – 59 months, <15% or <350; >5 years, <15% or <200)

It is important to note that clinical and laboratory monitoring of ARV clients, before and after someone has initiated ARV therapy, is an important component of the program. A number of tests, including liver function tests, are an essential part of treatment initiation. In addition, consideration and initiation of TB treatment or izonizaid preventative therapy (IPT) is an important element to be considered during the treatment initiation phase. Once someone has been initiated onto therapy, there are a number of regularly scheduled clinical monitoring appointments and laboratory tests to ensure that treatment is going according to plan.