AIDS: how does triple therapy work?

First appearing in 1996, the triple therapies have revolutionized treatments for AIDS, this having practically become a banal chronic disease like the diabetes or thehypertension. According to a 2017 study, triple therapies have increased life expectancy by 10 years in the United States and Europe. But what exactly is this therapy ? Triple therapy involves combining three classes of antiretrovirals (ARVs), which work by blocking certain stages of the blood cycle. replication of virus. This makes it possible to drop the viral load in the body which becomes almost undetectable.

The different types of antiretrovirals

There are many types of antiretrovirals, which work in different ways. Nucleoside inhibitors of reverse transcriptase of HIV (zidovudine, abacavir, lamivudine, emtricitabine …), produce deleterious mutations in the virus. The protease inhibitors (lopinavir, darunavir, atazanavir …) block a protein of the infected cell necessary for the virus to replicate. Inhibitors of fusion (Enfuvirtide) prevent the virus from entering healthy cells. Others warn the diffusion virus in the body or amplify the effects of other antiretrovirals. There are in all about twenty treatments available belonging to 6 different classes (one can find here a complete picture of available antiretrovirals). To increase the effectiveness of treatments, several antiretrovirals are often combined and act at different levels. This combination often consists of three molecules, hence the name triple therapy. However, some patients who respond poorly to treatment may take up to 8 or 10 different drugs.

Fewer side effects and almost zero risk of transmission

The first treatments had many side effects (fatigue, headaches, nausea and vomiting, fever, red patches on the skin, sleeping troubles…) and they were sometimes difficult for the patients to bear. Some of them had to take up to 20 tablets per day, several of which had to be stored at the fridge. Medicines have now made many advances and allow you to follow a practically normal life. Some manufacturers associate several molecules in a single pill (eg dolutegravir + abacavir + lamivudine or darunavir + cobicistat + tenofovir alafenamide + emtricitabine), so that you do not need to take more doses.

In addition to considerably increasing the life expectancy of people with AIDS, antiretrovirals reduce the risk of transmitting the virus by 96% to a partner during intercourse (it is still recommended to use a condom). While it was previously recommended to wait for a decrease in CD4T cells to start antiretroviral treatment, it is now advisable to start tritherapy. as soon as one becomes aware of the infection.