What exactly are ARVs?

By Dr Sindi

Antiretroviral treatment (ART) – what is it and how does it work?

ARV = antiretroviral. An antiretroviral is a drug that works to deal with infections caused by a retrovirus. In our setting the main retrovirus we deal with is HIV

ART = antiretroviral treatment. A combination of 3 or more ARVs taken daily to suppress HIV's ability to replicate

Antiretroviral treatment ART is taken to slow down the life cycle of HIV.

HIV multiplies by infecting CD4 cells, and using these cells to make millions of copies of itself. These copies are what we call the “viral load”. This process destroys the CD4 cell because the cell has been hijacked and is being used for something it is not meant for.

The CD4 cells are a very important part of your immune system. They are the "soldiers" of the immune system and their job is to identify whatever is making you sick, and get the body to fight the infection.

The lower the CD4 count drops, the higher the viral load goes, the weaker your immune system becomes. You then become vulnerable to what we call opportunistic infections and if you get too ill you could die. Taking ART reverses this process and ensures that your CD4 count can go up again and that the viral load comes down.

At the onset of the HIV pandemic, people had to take many tablets twice a day to stay healthy but we have advanced to the stage where some people are taking one-pill once-a-day. This is an important advance because people are not discouraged to take medication any longer. The one-pill once- a-day is a Fixed Dose Combination (FDC) of three different tablets that have been combined into one tablet.

The FDC we are all familiar with is part of our first line treatment. The originator FDC is Atripla but because of its cost, it was not accessible to everyone. Generics then came onto the market and this is how South Africa has managed to give FDC at its public sector clinics.