Indications for starting ART include:

the presence of clinical symptoms of secondary diseases, which indicates the presence of immunodeficiency;

decrease in the number of CD4 lymphocytes in the blood;

the presence of active HIV replication, assessed by the level of HIV RNA in the blood plasma.

In the absence of clinical symptoms of secondary diseases, the main criterion for starting ART in patients with chronic HIV infection is the number of CD4 lymphocytes. Almost all experts are unanimous in the opinion that if the CD4 lymphocyte count is less than 200/μl, treatment should be started immediately.

Almost all recommendations specifically emphasize that the patient must be ready to begin treatment, understand its goals and be committed to therapy, i.e. take medications prescribed by the doctor in the specified dosage, at certain time intervals, and in accordance with the recommendations for use food, liquids and other medications and dietary supplements (possible drug interactions). Treatment is prescribed only after the patient has signed a voluntary informed consent form.

In addition to the presence of clinical symptoms of secondary diseases, a decrease in the number of CD4 lymphocytes less than 350/ml, the criterion for prescription of ART is a high level of viral load (HIV RNA more than 100,000 copies/ml).

Particular difficulties arise for a doctor when deciding whether to prescribe ART to a patient who has been diagnosed with acute HIV infection. Currently, there is no consensus among specialists on the advisability of using ART in the acute period of HIV infection.

In accordance with Russian recommendations, treatment for patients in the acute period of HIV infection is indicated if the patient has a decrease in the number of CD4 lymphocytes to less than 1200/ml (stages 2A and 2B) or stage 2B of HIV infection has been established (acute HIV infection with secondary diseases) and at the same time the number of CD4 lymphocytes is reduced to less than 350/μl. The duration of antiretroviral therapy in patients with acute HIV infection usually ranges from 6 to 12 months.

1. First line ART schemes

The basal regimen is the regimen prescribed to most patients. Alternative regimens include ART regimens used for special categories of patients due to the impossibility of prescribing them a basic regimen due to contraindications. First-line ART regimens refer to those prescribed to patients who have not previously received ARVs. Second-line regimens refer to ART regimens used in case of ineffectiveness of the first-line therapeutic regimen.

Most existing recommendations suggest that the preferred first-line ART regimen include 2 drugs from the group of HIV nucleoside reverse transcriptase inhibitors (NRTIs) and 1 boosted HIV protease inhibitor (PI) or non-nucleoside HIV reverse transcriptase inhibitor (NNRTI - efavirenz or nevirapine). Regarding the combination of NRTIs, almost all experts advise the use of combination drugs that include 2 NRTIs. Currently, doctors have 3 drugs in their arsenal, each containing 2 NRTIs: Combivir (zidovudine + lamivudine), Kivexa (lamivudine + abacavir) and Truvada (tenofovir + emtricitabine).

The advantages of these combination drugs include taking 1 capsule once a day, regardless of food intake, and no effect on hematopoiesis. The most significant adverse effect when using Kivexa is the development of a delayed-type hypersensitivity reaction (DHT) to abacavir.

Taking into account the above data, the optimal choice of the initial combination of two NRTIs in Russia is the drug Combivir (zidovudine + lamivudine), which is prescribed 1 tablet 2 times a day. If anemia or neutropenia is present, phosphazide or stavudine in combination with lamivudine can be used instead of zidovudine.

When using other combinations of drugs from the NRTI group, the presence of drug interactions between drugs should be taken into account:

When taking didanosine and stavudine simultaneously, the risk of developing lactic acidosis increases significantly. The combination of these drugs is contraindicated in pregnant women;

If the patient has polyneuropathy, the combination of didanosine and abacavir leads to a significant increase in it;

When tenofovir and didanosine are combined, the concentration in the blood of the latter increases significantly, which leads to an increased risk of developing pancreatitis and peripheral polyneuropathy. In addition, this combination of drugs leads to a weak immunological response to ART;

Combinations of the drugs zidovudine (or phosphazide) + stavudine and lamivudine + emtricitabine should not be used, since these drugs are analogues of the nucleosides thymidine and cytidine, respectively. When these drugs are taken simultaneously, the effectiveness of treatment decreases because they compete with each other for intracellular enzymes that carry out the process of drug phosphorylation.

As a third drug in the ART regimen, experts suggest including either a drug from the NNRTI group or a PI boosted with ritonavir. Among drugs from the NNRTI group, it is recommended to include nevirapine or efavirenz in the first-line ART regimen, with preference given to efavirenz. A significant limitation in the use of nevirapine is the high content of CD4 lymphocytes (more than 250/ml in women and 400 in men), which significantly increases the incidence of severe hepatotoxicity. Efavirenz is not recommended for pregnant women and women planning pregnancy due to the increased likelihood of developing fetal pathology (especially when using the drug in the first trimester of pregnancy).

ART regimens differ in their safety profile, i.e. frequency and severity of certain adverse events. It is this indicator that can be decisive when drawing up a therapeutic regimen for a particular patient. In addition, the convenience of taking the drugs, the presence of concomitant diseases or conditions, as well as possible drug interactions between ARVs and the drugs the patient is taking are also taken into account. From the point of view of the optimal combination of effectiveness and ease of administration, an ART regimen that includes the drugs tenofovir, emtricitabine and efavirenz has a certain advantage. The combined drug Atripla contains all these three drugs in 1 tablet, which the patient takes once a day, regardless of food and liquid intake.

In Russian recommendations, one of the main criteria for choosing the preferred first-line ART regimen is the cost of the ART regimen. When choosing a basic first-line ART regimen, Russian specialists took into account, in addition to cost, effectiveness, safety, tolerability, ease of administration, as well as the presence of this regimen in foreign recommendations. In accordance with Russian recommendations, the preferred ART regimen is a regimen that includes the drugs Combivir (zidovudine + lamivudine) and efavirenz (2 NRTIs + NNRTIs). The patient needs to take 1 tablet in the morning and 2 tablets in the evening, and the cost of such an ART regimen, within the framework of the National Project, is less than 1800 US dollars per year.

Highly active antiretroviral therapy (HAART) is the mainstay of treatment for HIV and AIDS. Despite the inevitable outcome of immunodeficiency, antiviral drugs help to significantly prolong life and delay the terminal stage of the disease. From the moment a person was first infected with HIV to this day, scientists have been trying to improve HAART, select the optimal combination of medications and reduce side effects, believing that this approach will ultimately help create a drug that completely destroys the retrovirus.

The main goals of therapy are to reduce the viral load and increase the level of T-lymphocytes. HAART is aimed at suppressing the activity of the retrovirus, which is directly related to the state of the immune system and the patient’s well-being. This defines another goal of treatment - improving the quality of life of patients with HIV and reducing morbidity and mortality due to AIDS. Against the background of HAART, if treatment is effective:

• a person can live a full life for many years (up to 70 years);
• without clinical manifestations of immunodeficiency;
• without the addition of concomitant pathologies;
• without chemoprophylaxis of opportunistic infections;
• it is relatively easy to tolerate seasonal colds and allergic reactions;
• due to the low titer of the causative agent of immunodeficiency in the body, it should be safe for your sexual partner.

Such possibilities of modern HAART allow HIV-infected people to return to normal life and work, their condition and well-being do not interfere with full participation in society.

Basic principles of HAART for HIV patients

Antiretroviral treatment for HIV must meet modern requirements and standards:

• the use of schemes with proven long-term effectiveness;
• initiation of therapy at an early stage of the disease;
• the same effectiveness of the drugs used with the initially high and the resulting low viral load;
• the possibility of using other regimens if first-line regimens are ineffective (lack of cross-resistance);
• admissibility of simultaneous use of antiviral drugs and other medications;
• drugs with the lowest possible degree of side effects;
• therapy should be convenient to take (the smallest number of capsules or tablets, taken 1-2 times a day, regardless of meals).

For successful treatment, the requirements are imposed not only on HAART, but also on the HIV patient himself: the desire to be treated and take medications, compliance with doctor’s orders, timely visits to the hospital and tests, giving up bad habits and the desire for a healthy lifestyle.

Indications for starting HAART

Previously, HIV treatment was prescribed based on the belief: the stronger the treatment and the earlier it starts, the better the therapeutic effect will be. But this approach did not justify itself and currently HAART must be started under the following conditions:

• T-lymphocyte level below 350 cells/μl;
• Clinical stages 3 and 4 of HIV.

Now the main belief in HIV treatment is to fight immunodeficiency as effectively as possible, but only if necessary. The doctor must compare the patient’s condition, laboratory test data, the risk of AIDS, side effects of therapy and the possibility of early resistance to treatment - and only after assessing all these criteria, decide on prescribing HAART.

Approximate treatment regimens

Antiretroviral therapy for HIV can be divided into 3 types of regimens:

• first line – for patients who have not previously received HAART;
• second line – if the first line schemes are ineffective;
• backup schemes (“rescue schemes”, “despair schemes”).

Each scheme usually combines 3 or 4 antiviral drugs, each of which is aimed at a certain stage of retroviral DNA synthesis and its introduction into the host cell. After 6-8 months from the start of therapy, one can already evaluate its effectiveness: if the virus has mutated under the influence of the drugs used, then the viral load begins to increase and the level of T-lymphocytes decreases. Therefore, in the treatment of immunodeficiency, laboratory monitoring and dynamic observation are extremely necessary.

Features of the course of HIV against the background of HAART

If the treatment is effective and the patient complies with the prescribed regimen, then it is quite possible to achieve remission with HAART. In this case, the viral load is reduced to such a level that it is not detected by laboratory diagnostics, but this does not mean that the virus is completely destroyed and treatment can be stopped - the HIV pathogen is in an inactive state and when antiretroviral therapy is discontinued, the retrovirus will certainly become more active. Due to the increase in the level of T-lymphocytes, immunity can work almost like a healthy person, so an HIV-infected person is not at risk of opportunistic infections and secondary pathologies.

With HAART, the virus can be weakened so much that even pregnancy proceeds as in HIV-negative women and children are born completely healthy. Today, the presence of HIV infection, subject to treatment, is not a contraindication for natural childbirth. It is only important to select drugs that do not have embryotoxicity.

Side effects and contraindications

As with any treatment, side effects are possible with HIV therapy:

• metabolic disorders;
• damage to the digestive system (nausea, vomiting, diarrhea);
• hepatotoxicity;
• effects on the nervous system (headaches, memory loss, sleep disturbances, mood changes);
• decreased kidney function;
• allergic reactions;
• changes in blood composition (anemia, neutropenia, thrombocytopenia);
• inflammation of the mucous membranes.

According to statistics, up to 80% of HIV patients have some kind of side effects during HAART. In 6-10%, acute intolerance to the drugs used develops and therapy must either be changed or completely canceled. But canceling treatment naturally dooms the patient to inevitable death, so the treatment regimen is modified in every possible way and adjusted to the specific patient. For the same reason, there are no contraindications to HAART - doctors try to eliminate any limitation or obstacle to complete antiretroviral therapy.

Advisory Center Assistance | Side effects of HIV therapy

When people first start taking antiviral therapy, they usually get worse, not better. This is normal and you shouldn't be afraid of it.

HIV, antiviral therapy, HIV therapy

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How to cope with the side effects of HIV therapy?

Every antiviral drug can have side effects, but the same applies to absolutely any drug. Everything is very individual, and if you see a long list of side effects in the instructions for the drug, this does not mean that you will necessarily experience at least one of them. Some do not experience any side effects from therapy, others experience them in a mild form that does not complicate their lives, and for others the side effects can be severe.

The main rule in the fight against side effects from ART

The key to dealing with possible side effects is to know in advance what to expect and have a plan in place if any side effects occur. If you are going to take a drug that has even a slight chance of dangerous side effects, you should know the symptoms you need to watch out for in advance. It is also possible to reduce symptoms with specific preventive actions. Before you start taking therapy, discuss with your doctor the possible risks associated with the drugs.

Sex question

Women may respond differently to a variety of medications than men. It is still not entirely clear why this happens. It is possible that differences in body weight or sex hormones are to blame. Regardless, women need up-to-date information about side effects specifically among women.

What to watch for and what to do?

When people first start taking antiviral therapy, they usually get worse, not better. This is normal and you shouldn't be afraid of it. The vast majority of side effects disappear within 4-6 weeks after starting therapy. This period is necessary for the body to adapt to new medications. Before this happens, people may experience headaches, muscle pain, dizziness and nausea. Once your body gets used to it, these side effects should go away.

It is necessary to learn to recognize unwanted actions as soon as they appear. You can adapt to most side effects. In other cases, side effects may be a signal to seek medical help. After starting therapy, tell your doctor about any reactions that are unusual for you. If possible, try to talk to people who have taken the same drug. It is possible that they have encountered the same problem and have already found a solution.

Everything seems complicated at first

Very often people mistake symptoms of anxiety, stress and depression for side effects. Taking care of your WHOLE self, including your emotions, your health thoughts, and your HIV strategy will help you reduce negative feelings and their consequences.

The period of getting used to medications can be made easier and calmer. Try to unload your schedule in advance and do not plan serious matters or a large amount of work during this time. If you tend to have too much on your plate, ask someone for help, such as around the house or with babysitting.

At this time, your health should come first. Try to get plenty of sleep and rest. Eat properly, taking into account possible nausea or diarrhea. Try to do physical exercise every day - at least go for a walk.

During this time, you especially need the support of family, friends or self-help groups. If you can, tell them what is happening to you. Sometimes just talking helps, but you may also have a good idea for side effects that your doctor didn't even mention.

Something about changing ART drugs

Sometimes people experience really serious side effects that may make them want to switch to a different regimen, even if their medications are well controlled HIV.

Changing a drug solely because of side effects will also allow you to “save” that drug for the future if the current combination fails. Moreover, the side effects you experience now may not occur again if you try this medicine in the future.

However, you should remember that simply stopping taking a particular drug is very dangerous. It is also dangerous to reduce the dose of a medicine without talking to your doctor. This may lead to the development of resistance to this drug, and possibly to other drugs in this class.

Side by side with the side effects of HAART

Side effects very often appear after starting treatment antiviral therapy, but after a few weeks they decrease or disappear completely. Sometimes they may continue throughout the duration of the combination, but even then they can be minimized and many people decide to continue taking therapy despite symptoms.

Most drug-related symptoms are similar to illnesses that people have dealt with before, such as hormonal imbalances, pregnancy, depression, or HIV infection itself. Whatever concerns a person, it is very important to discuss it with a doctor and diagnose the cause of the ailment.

Recommendations for dealing with the most common side effects:

Chronic fatigue

We all feel tired from time to time, but if the fatigue continues constantly, regardless of the circumstances, then it is a medical problem. If ignored, it may get worse.

Symptoms of fatigue can be physical. For example, difficulty getting up in the morning or walking up the stairs. They can be psychological. For example, the inability to concentrate on something. Chronic fatigue can have many possible causes that may not always be immediately diagnosed.

The first step in fighting chronic fatigue is recognizing it. If you feel constantly tired, ask yourself: How quickly do you get tired? Do you find it difficult to do something that you had no problem with a couple of months ago? Is it easy for you to concentrate on something? Are you sleeping well? The more information you provide your doctor about your physical and psychological condition, the easier it will be to find a cure for your condition.

• Try to go to bed and get up at the same time. Changes in your sleep routine can cause fatigue.
• Try to exercise at least a little physically. This will reduce stress and help you feel stronger.
• Buy more prepared foods to save yourself the hassle of cooking.

Anemia

Anemia is the loss of red blood cells. With anemia, the body's tissues lack oxygen, which causes a feeling of fatigue and loss of strength. In women, a symptom of anemia may be irregularities in the menstrual cycle. In some cases, anemia can be dangerous to your health. Most people with HIV experience anemia at some point in their lives.

Sometimes the cause is the HIV infection itself; in other cases, certain antiviral drugs, such as retrovir, can cause anemia.

To diagnose anemia in a timely manner, it is necessary to monitor the number of red cells. Diet changes and special nutritional supplements can reduce the risk of anemia. There are also special medications for its treatment. In the worst cases, you need to stop taking the drugs and change the combination.

• Get your red blood cell (hemoglobin) count checked regularly.
• Fish, meat and poultry are rich in iron and vitamin B-12. Both of them reduce the risk of anemia.
• Spinach, lettuce, asparagus, and green peas are rich in folic acid, which is also useful for preventing anemia.

Headache

The main cause of headaches is tension, which we can all experience. However, some medications, including antivirals, can cause it. There are many medications for headaches. It can also be reduced by reducing stress.

• Try relaxing in a room where it is dark and quiet, close your eyes.
• Place a cold compress on your eyes, gently massage your cheekbones, and take a hot bath.
• To prevent headaches, try to find out what may trigger them. Avoid foods that may trigger it, especially caffeine (found in coffee, tea, and cola), chocolate, wine, citrus fruits, dietary supplements, cheese, onions, and vinegar.

Nausea and vomiting

Some of the antiviral drugs may potentially cause nausea in some people. If you experience vomiting, especially if it has become chronic, you should urgently contact your doctor, especially since it may interfere with taking medications.

• Include bananas, rice, apple juice and toasted bread in your diet.
• Leave some dry crackers or bread next to your bed. Before getting up, eat a couple and sit in bed for a while. This will help fight morning sickness.
• Try mint, chamomile or ginger tea. They can soothe the stomach.
• Avoid hot, spicy, strong-smelling and greasy foods.
• Talk to your doctor about the possibility of prescribing anti-nausea medications.

Diarrhea

Chronic diarrhea can lead to dehydration, so in this case you should try to drink as much fluid as possible and also eat well. There are many very good anti-diarrhea medications. If your medications may cause it, talk to your doctor about prescribing such medications in advance.

• Eat plenty of bananas, cooked rice, apple juice, cereals and bread (non-grain) - this is an excellent home remedy for diarrhea.
• Avoid foods with insoluble fiber, such as fruits and vegetables with skin. They can make diarrhea worse.
• Try to avoid fatty or very sweet foods.
• Take calcium (500 mg twice daily).
• Drink plenty of fluids to prevent dehydration.

Dry mouth

Dry mouth can occur as a result of taking certain medications. The main treatment in this case is to drink plenty of fluids and, if possible, avoid sweet foods and caffeine. Sugar-free gummies are a good way to overcome dryness. If this does not help, you should consult your doctor about prescribing special medications.

• Rinse your mouth regularly with warm water.
• Try sucking on a sugar-free candy, ice, or chewing gum.
• Ask your doctor to prescribe a mouth rinse or special medications.

Rash

For reasons that are not yet clear, the rash is more severe in women taking antiviral drugs than in men. The rash usually appears in people taking nevirapine or nelfinavir. It is very important to monitor the condition of your skin, especially after prescribing a new drug, and immediately consult a doctor in case of any symptoms.

• If possible, replace soap with other cleansers, use neutral, unscented soap.
• Avoid unnecessary baths and showers, they irritate the skin.
• Try not to sunbathe and avoid ultraviolet radiation from the sun, as it can worsen the rash.
• Purchase anti-rash medication that softens the skin in advance and keep it on hand.

Both AIDS and AIDS are incurable diseases, but their progression can be slowed through lifelong use of special medications. Combination antiretroviral therapy involves the use of three or four drugs, depending on the stage of the disease and the dosage prescribed by the doctor.

How does antiretroviral therapy work?

The immunodeficiency virus is highly mutagenic. This means that it is highly resistant to various adverse effects and is capable of changing its RNA, forming new viable mutations. This property significantly complicates the treatment of HIV and AIDS, since pathogenic cells very quickly adapt to the drugs taken.

Antiretroviral therapy is a combination of 3-4 different medications, each of which has a special principle of action. Thus, taking several drugs ensures the suppression of not only the main type of virus, but also any of its mutations formed during the development of the disease.

When is antiretroviral therapy prescribed?

Naturally, the sooner treatment for HIV infection begins, the better it will be to stop the progression of the virus and improve the patient’s quality and life expectancy. Considering that early symptoms of the disease usually go unnoticed, antiretroviral therapy is prescribed approximately 5-6 years after infection, in rare cases this period is extended to 10 years.

Highly active antiretroviral therapy drugs

Medicines are divided into classes:

1. Reverse transcriptase inhibitors (nucleoside):

• Videx;
• Tenofovir;
• Kivexa;
• Retrovir;
• Abacavir;
• Zerit;
• Lamivudine;
• Trivisir;
• Emtriva.

2. Non-nucleoside reverse transcriptase inhibitors:

• Viramune;
• Stockrin;
• Delavirdine.

3. Protease inhibitors:

• Indinavir;
• Kaletra;
• Aptivus;
• Inviraz;
• Ritonavir;
• Reyataz;
• Prezista;
• Nelfinavir;
• Agenerase;
• Telzir.

Fusion inhibitors belong to the newest class of drugs for active antiretroviral therapy. So far, only one drug is known - Fuzeon or Enfuvirtide.

Side effects of antiretroviral therapy

Non-hazardous negative effects:

His name is AIDS Vyacheslav Zalmanovich Tarantul

Three or more (highly active antiretroviral therapy (HAART))

Three or more

(highly active antiretroviral therapy (HAART))

Currently, when treating HIV infection, it is recommended to use more complex combinations of HIV inhibitors. From numerous large-scale studies, it has become clear that not individual drugs or even two different drugs, but only three or more combinations can provide a noticeable positive effect. This approach is called combination therapy, or highly active antiretroviral therapy (HAART in English HAART). HAART is currently considered the most effective way to inhibit the development of HIV and reduce the number of viruses to a level at which they become indistinguishable in the patient’s blood using modern diagnostic methods. The immune system restores its potential. This is understandable: cessante causa, cessat effectus (with the cessation of the cause, the effect ceases).

Triple combinations of antiretroviral drugs have become the internationally accepted standard of care. In tritherapy, two NRTIs are often given in combination with either a protease inhibitor (such as Saquinavir or Nelfinavir) or an NNRTI (the drugs Nevirapine or Ifavirenz). Such an active drug effect, which has simultaneous effects on different parts of the life cycle of the virus, significantly reduces its viability. With this approach, two “targets” are affected at once, and here the viruses have a very difficult time; they practically stop reproducing. If one of the drugs does not fully work, at the next stage of the virus’s development another will “insure” it. Taking such “cocktails” sharply reduces the viral load and increases the number of CD4 lymphocytes in the blood.

The use of cocktails of drugs has made it possible to significantly prolong the life of a person with HIV infection and prevent the development of the disease. Often this approach leads to the restoration of working capacity in patients who already had all the signs of AIDS. In Western Europe and North America, triple antiretroviral therapy began in the mid-90s. last century, and by 1999 about 85% of AIDS patients received it. As a result, since 1995, mortality from HIV infection in the countries of these regions has decreased by approximately 7–8 times. If out of every hundred people with AIDS, 33–34 people died per year, now 3–5 die. Today, most patients taking the drugs have a high chance of living 10 years, and possibly even longer. Thanks to HAART, the incidence of Kaposi's sarcoma in patients with HIV has significantly decreased.

All this has proven the high effectiveness of tritherapy. It not only significantly extended the life of patients, but also maintained an acceptable quality of life by maintaining the immune system at a level that prevents the occurrence of infections and cancer, which, as a rule, become the direct cause of death. As a result of the use of tritherapy, patients with signs of AIDS regained normal health and even became able to work. At first, the successes of tritherapy were spoken of as “the light at the end of the tunnel, marking the transition from panic to hope.”

However, HAART has not yet become a panacea for AIDS. Unfortunately, the therapy used today only partially solves the problem. This is due to a number of reasons.

First, about 20% of HIV-infected people cannot tolerate some of the components included in the medications they use.

Secondly, most of the drugs are toxic to the body and destroy it from the inside. Thus, almost all HIV inhibitors cause side effects. The most common of them are nausea, vomiting, diarrhea (diarrhea), insomnia. Other side symptoms are more specific. Two side effects are common to HIV reverse transcriptase inhibitors. This is neuropathy - damage to nerve endings, manifested in the form of numbness in the limbs, increased or decreased skin sensitivity, muscle spasm, pain, and pancreatitis - inflammation of the pancreas. The use of certain drugs leads to disturbances in the distribution of adipose tissue on the body. This is not life-threatening, but it greatly spoils the appearance: excess fat deposits appear on the chest, abdomen and neck, and the face, arms and legs become unnaturally thin. Some patients cannot accept this.

Thirdly, HIV is able to adapt to medications, and they become unable to prevent it from multiplying. Doctors are concerned about the increasing resistance of HIV to existing antiviral drugs. According to the latest data, such resistance (resistance) occurs in at least 10% of identified HIV-infected people.

Fourth, HAART is very expensive (from 6 to 20 thousand US dollars per year). Not everyone, even in the USA, has that kind of money. This makes HAART inaccessible to many people.

Finally, fifthly, the medication regimen is very strict, and not all patients are able or willing to comply with it. A person undergoing complex anti-HIV therapy must sometimes take from 5 to 20 different tablets strictly every 8-12 hours. And so constantly, for many months and years. In addition, taking certain medications requires following a strict diet and eating according to the clock. Even the most punctual patients are unable to follow such strict recommendations like machines. Errare humanuni est (people tend to make mistakes). Rigid use of medications can cause psychological fatigue in the patient.

It is also known that two or more drugs, when used together, can sometimes have cross-effects on each other. One drug may weaken or even neutralize the pharmacological action of another. The interaction of two medications used simultaneously can increase the side effects of each of them. And yet, despite the fact that the cross-effect of drugs is known, their combinations are prescribed to patients for health reasons. In such cases, additional monitoring of vital body functions is usually carried out to prevent side effects.

And the effectiveness of HAART, correctly used today, is not yet high in all cases. According to published observations by Swiss scientists who examined a large group of HIV-infected people, after four years of treatment with HAART, only 39% of patients had an immune status (the number of cells carrying CD4) above 500 cells/ml.

Certain hopes are now pinned on a course of treatment based on the “7–7” principle. It starts with 7 days without antiretroviral therapy, after which HIV-positive people take didanosine (ddl), lamivudine (3TC) and efavirenz once a day for 7 days, and then go back to rest. This cycle repeats for more than one year. Testing of this scheme on seven volunteers showed the effectiveness of this course of treatment. It is important that this reduces the cost of medications, reduces their toxic effect, and a week of rest after a week of taking it greatly simplifies the life of HIV-infected people.

If at the very beginning of the epidemic it was almost impossible to slow down the course of the disease at the AIDS stage, modern drugs can extend the life of an HIV-infected person, and this extension is sometimes quite significant - up to 10–15 years. And perhaps more, since the disease itself appeared relatively recently, and scientists do not have even longer observations. Nevertheless, it is clear that if such treatment could have been used 10–20 years ago, Freddie Mercury, Rudolf Nureyev, and thousands of other famous and little-known people whose lives have already been claimed by the epidemic could be alive today.

But so far these are still only the first successes. Even HAART did not transfer AIDS from an absolutely fatal disease to a group of diseases that, like diabetes, require only the constant use of certain medications to guarantee a person’s existence.

So, some progress in the treatment of HIV infection has been achieved. “We can be largely satisfied with the medicines that are available,” said RAMS academician Vadim Pokrovsky back in April 2002.

However, drugs purchased abroad are very expensive, and for this reason they are clearly not enough. Currently in Russia only one company is engaged in the production of anti-HIV drugs - the AZT company, which produces Nikavir and Timozide. The production of Stavudine is expected to begin soon. The price of these medicines is two times lower than foreign ones. This makes the situation a little easier, but does not solve it completely. The production of other drugs is blocked by licenses from foreign manufacturing companies.

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