Courtesy of Education Subcommittee of the Patient Care Committee of the Adult AIDS Clinical Trials Group

An antiretroviral (ARV) is not a cure for HIV; it only slows the disease’s progress. Therefore, even when taking ARVs, you must consider yourself infectious, and you must take your ARV exactly as prescribed.

An ARV is any medication that acts directly on HIV to keep it from reproducing. There are currently five kinds of ARVs that differ in where they act in the reproductive cycle:

• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Protease inhibitors (PIs)
• Fusion inhibitors (FIs)
• Interleuken inhibitors (IIs)

They all have different ways of doing the same thing: keeping the virus from making more copies of itself.

Reverse transcriptase inhibitors (RTIs) prevent the virus from making more copies of its genetic material. This keeps it from making the rest of the proteins and sugars needed to build more copies. There are two types: nucleoside (NRTIs) and non-nucleoside (NNRTIs).

RTIs are inserted in the growing genetic material and act as a block to prevent finishing the construction process. RTIs include drugs like AZT, ddC, ddI, D4T, 3TC, and 1592. NNRTIs bind to the enzyme Reverse Transcriptase to keep it from building the genetic material. NNRTIs include drugs like delavirdine, nevirapine, and Efavirenz.

Protease inhibitors block the HIV protease enzyme from breaking apart long chains or proteins and sugars into the smaller pieces needed to build a new virus. Drugs in this class include saquinavir, ritonavir, indinavir, nelfinavir, and VX-478.

By preventing the virus from reproducing, we hope to halt the destruction of your immune system that HIV causes. Another point to remember is ARVs do not kill the virus! As long as you take your medications exactly as prescribed, the damage already done to your immune system can be slowed. "Can be" is very important here because we don't know exactly how long any ARV taken properly will work. That will vary from person to person, and there is no way to predict that at the moment.

In addition to bringing a medical benefit, the ARVs have many side effects. This is not peculiar to the ARVs; all medications have side effects. Unfortunately the side effects of ARVs may be more dramatic than with other medications. Most of these side effects are manageable by changing your dose. Sometimes another medication might be prescribed to treat the side effect. It all depends on the side effect and your physician's assessment of your problem.

So please keep in mind the following:

• ARVs are treatments, not cures. A cure would eliminate the virus from the body. At best, ARVs only slow the disease process.
• Because ARVs are only treatments, you must consider yourself infectious. It is still possible for you to transfer the virus to other people by sexual contact, sharing IV needles, or through child birth or breast feeding. If you have any questions about the chances of giving AIDS to someone else, talk to your doctor, nurse, or pharmacist.
• Take your ARV exactly as prescribed. Do not change your dose or stop taking it on your own, even if you are having side effects. If someone other than the clinic staff suggests changing your dose, check with the clinic before doing so.