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March 15, 2004

First Line ART: 2 Nukes + 1 Non-Nuke

We're starting to get involved with providing antiretroviral drugs. Can you please tell me the current thinking about triple-therapy ART recommended for the developing world?

For "first line" therapy for adults and adolescents, WHO recommends a combination of 2 NRTIs plus 1 NNRTI (see Table.) (Sometimes categorized as "2 nukes and a non-nuke".) Each of the 4 recommended regimens contain Stavudine, plus one of the other NRTIs and one of the 2 NNRTIs.

Leading Nucleoside RTIs (Nucleoside Reverse Transcritase Inhibitors)
Zidovudine(ZDV)
Stavudine(d4T)
Lamivudine(3TC)

Leading Non-Nucleoside RTIs  (Non-nucleoside Reverse Transcriptase Inhibitors)
Nevirapine(NVP)
Efavirenz(EFZ)

Also it is Lamivudine (not Stavudine) that is in each of the 4 WHO-recommended regimens along with one other NRTI and one NNRTI.

All of these drugs work by blocking "reverse transcriptase" - a key enzyme that makes HIV DNA in the human cell.

WHO has recently issued a new version of its excellent guide to ART. It also includes recommendations for a variety of clients including women of childbearing age, pregnant women, children, and people with TB. It is available at the WHO website.

References:
WHO. Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach. 2003 Revision. Geneva, 2003.

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The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)

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