Antiretroviral are medications for the treatment of infection by retroviruses, primarily HIV

In IndonesiaData from Kementerian Kesehatan(Kemenkes),2010

as much as 1.206 cases of AIDS 1978 - 30 June 2010 21.770 cases Ratio Male : Female 3:1

WHY increasing.1.Lack of concern from the community2.More doctors are well-trained to detect AIDS3.The HIV that attacks immune system can be spread.

HIGHEST CASES Jakarta, Jawa Barat, Jawa Timur, Papua, Bali, Sulawesi Selatan, Sumatera Utara, Riau, Sumatera Barat

Nucleoside Reverse Transcriptase Inhibitor (NRTI) -emtricitabine (FTC),

Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) -capravine (CPV)

Protease Inhibitors (PIs)- ritonovir (RNV)- tipranavir (TPV)- atazanavir (ATV)

Fusion Inhibitor- enfurtivide (T-20)

Intergrase inhibitors

Maturation inhibitors

STRATEGIESOnce-Daily RegimensAntiretrovitralTreatmentSimplificationDouble NNRTI RegimensNucleoside Analogue- Sparing RegimensProactive AntiretroviralSwitchingStructured Treatment Interruptions

WHAT IS HAART ????Antiretroviral are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as highly active antiretroviral therapy, or HAART

ARV attacks the HIV(Different Style & Approaches)

ARV does not kill/destroy HIV virus, but only delays the replication of the HIV virus (Delays progression of HIV)

ARV generally used in combination with 3 or more ARV belonging to >1 generation (Combination Therapy @ ART)

ART works better than single ARV (prevents resistance to occur)

33333333NRTINNRTIInhibit genetic material of HIV which is used to make DNA from RNA NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR (NRTI)

3TC (lamivudine) Abacavir (ABC) AZT (ZDV, zidovudine) d4T (stavudine) ddI (didanosine) Emtricitabine (FTC) Tenofovir (TDF; analog nukleotide) Nucleoside Reverse Transcriptase Inhibitor MutationMutation at position 41 , 215 causes resistance of zidovudine

NN NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR (NNRTI) Delavirdine (DLV) Efavirenz (EFV) Etravirine (ETV) Nevirapine (NVP) Nonnucleoside Reverse Transcriptase Inhibitor Mutation Mutation at position 106 causes resistance of nevirapine

Disables active site of enzyme &inhibits further replication PIPROTEASE INHIBITOR Atazanavir (ATV) Darunavir (DRV) Fosamprenavir (FPV) Indinavir (IDV) Lopinavir (LPV) Nelfinavir (NFV) Ritonavir (RTV) Saquinavir (SQV) Tipranavir (TPV) Protease Inhibitor Mutation

Mutation at position 54 causes resistance of indinavir, ritonavir, amprenavir, and saquinavir

Entry Inhibitor inhibits insertion of HIV virus into cell

Enfuvirtide (T-20) Maraviroc (MVC)

Integrase Inhibitor (INI) prevent genetic code of HIV from combining with genetic code of cell.

Raltegravir (RGV)

SUMMARY

- Increases life span - Prevents MTCT - Reduce HIV viral load in blood - Increases CD4+ cell count - Reduce HIV viral replication in body- Slow progression of HIV- HAART = 2 RTI + I PI- Given when CD4 below 350. (High chances for opportunistic infection)