What is the treatment for Human Immunodeficiency Virus (HIV) type 1 and type 2?

From the Guidelines

The treatment for Human Immunodeficiency Virus (HIV) type 1 and type 2 is antiretroviral therapy (ART), which typically consists of a combination of medications, including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase inhibitors (IIs).

Key Components of ART

• Initial Regimens: The recommended initial regimens consist of an InSTI (Integrase Strand Transfer Inhibitor) plus 2 NRTIs 1
• Alternative Regimens: Alternative regimens include a protease inhibitor (PI) with two NRTIs, a nonnucleoside reverse transcriptase inhibitor (NNRTI) with two NRTIs, or a 3-NRTI regimen 1
• Treatment Goals: The goal of ART is to achieve a viral load of <50 copies/mL within 4–6 months of starting treatment 1

Management of HIV-1 and HIV-2

• Similar Management: Persons with HIV-2 should be managed similarly to those with HIV-1, as the modes of transmission and preventive counseling are the same 1
• Epidemiologic Importance: Additional testing to define the virus type is of epidemiologic importance and should be considered for persons with epidemiologic risk factors for infection with HIV-2 1

Key Points

• ART is the cornerstone of HIV treatment and prevention 1
• Combination therapy is more effective than monotherapy 1
• Resistance testing is a useful tool in selecting active drugs when changing antiretroviral regimens after virologic failure 1

From the Research

Treatment for HIV-1 and HIV-2

The treatment for Human Immunodeficiency Virus (HIV) type 1 and type 2 involves the use of antiretroviral therapy (ART).

• For HIV-2, effective drugs include:
  • Nucleoside analogue reverse transcriptase (RT) inhibitors (e.g. zidovudine, tenofovir, lamivudine, emtricitabine, abacavir, stavudine and didanosine) 2
  • Protease inhibitors (saquinavir, lopinavir and darunavir) 2
  • Integrase inhibitors (raltegravir, elvitegravir and dolutegravir) 2, 3
• For HIV-1, there are six distinct classes of drugs:
  • Nucleoside-analog reverse transcriptase inhibitors (NRTIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Integrase inhibitors
  • Protease inhibitors (PIs)
  • Fusion inhibitors
  • Coreceptor antagonists 4
• Combination therapy, such as zidovudine, lamivudine, and lopinavir-ritonavir, can provide efficient and durable suppression of HIV-1 and HIV-2 for as long as 3 years in HIV-2-infected and dually infected patients 5
• However, the emergence of HIV-1 and HIV-2 strains containing drug-resistant mutations can compromise the efficacy of this highly active ART 5, 3

Drug Resistance

• HIV-2 strains are naturally resistant to some antiretroviral drugs developed to suppress HIV-1 propagation, such as nonnucleoside RT inhibitors, several protease inhibitors, and the fusion inhibitor enfuvirtide 2, 3
• Resistance selection in HIV-2 appears to be faster than in HIV-1 2
• New drugs are needed to treat infection with drug-resistant isolates 3
• The development of novel drugs specific for HIV-2 is an important priority 2