HIV and the Treatment of AIDS

HIV is a member of the retrovirus family (see Table 34-1).32 HIV impairs the function of certain cells in the immune system such as CD4+ (T-helper) lymphocytes.11,26 Destruction of immune system components often leads to the severe immunocompromised state known as AIDS. This virus exists in at least two forms HIV-1 and HIV-2. Both forms of the virus are capable of causing AIDS, but HIV-1 is more prevalent.32 Hence, HIV-1 is also referred to informally as the AIDS virus. Because there is currently no effective way to kill the AIDS virus in humans, there is no cure for AIDS. 

AIDS is a life-threatening disorder because of the susceptibility of the immunocompromised patient to severe infections and certain forms of cancer.65 73 76 101.113 [n particular, patients with AIDS often suffer from severe viral infections (CMV, various herpesvirus infections), bacterial infections (Mycobacterium tuberculosis), fungal infections (Pneumocystis jiroveri), and infections caused by various other microbes and parasites. Patients with AIDS also develop relatively unusual neoplastic diseases, such as Kaposi sarcoma. 

Considerable neuromuscular involvement also occurs in patients with AIDS.47 100 Peripheral neuropathies, myopathies, and various CNS manifestations (dementia, other psychological manifestations) can occur directly from HIV infection or secondarily, due to some other opportunistic infection.31 85 100 Likewise, peripheral neuropathies are a common side effect of certain anti-HIV drugs (didanosine, stavudine, zal-citabine), and myopathies are a side effect of zidovudine therapy.63 Patients with HIV disease often have painful symptoms such as joint pain, back pain, and pain related to neuropathies and myopathies.100 Hence, HIV disease can often be regarded as a degenerative neuromuscular disorder from the standpoint of a rehabilitation professional. Therapists can therefore help improve function and decrease pain in patients with HIV infection and AIDS.1 33 

The treatment of patients with AIDS and individuals infected by HIV is continually being modified as new drugs become available and more information is gained about the nature of the AIDS virus. Currently, the pharmacologic management of HIV-infected patients consists of two principal strategies (1) controlling the proliferation and effects of HIV in individuals infected with this virus and (2) treatment and prevention of various opportunistic infections that 

The third strategy developed to inhibit HIV replication is the NNRTIs. These drugs include delavir-dine (Rescriptor), efavirenz (Sustiva), and nevirapine (Viramune). Fike their nucleoside counterparts, NNR- 

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Protease inhibitors are often incorporated into the comprehensive treatment of people with HIV infection. Use of these drugs in combination with other anti-HIV agents is discussed in more detail later in this chapter (see HIV and the Treatment of AIDS ). In addition, a specific protease inhibitor can be combined with a low dose of ritonavir—a process known as protease-inhibitor boosting. 34,69 Ritonavir inhibits the hepatic breakdown of the other (primary) protease drug, thereby enabling the primary drug to exert better therapeutic effects at a lower dose.34... 

Therefore, several types of RTIs are available that can help prevent HIV replication and inhibit the proliferation and spread of this virus to noninfected cells. Although these drugs do not kill HIV, RTIs are the cornerstone of treatment for preventing the progression of HIV disease.59 Use of the various RTIs in combination with each other and with other anti-HIV drugs is discussed in more detail in HIV and the Treatment of AIDS, later in this chapter. 

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