HIV is a virus that attacks the human immune system and kills specific white blood cells that fight infections. These cell types are commonly known as CD4 cells. HIV kills these CD4 cells, making it unable to fight common infections in the body. As HIV evolves, the decline in CD4 cells can lead to what doctors call opportunistic infections. However, early treatment can help prevent this effect. Doctors may use NRTIs as part of their treatment plan for someone with HIV. NRTIs prevent HIV from replicating and killing CD4 cells. This article provides an overview of treating HIV using NRTIs. Explains how they work and lists the approved drugs currently available as treatment options. NRTIs are one of the types of antiretroviral drugs that treat HIV. They work by preventing the virus from multiplying in the body. Specifically for HIV, NRTIs work by blocking reverse transcriptase, the enzyme that HIV needs to reproduce. HIV cannot reproduce on its own, which means that it needs a cell to multiply. The cells that HIV enters are CD4 cells, which are white blood cells that fight infections. Once HIV enters CD4 cells, it changes its RNA to DNA using the reverse transcriptase enzyme. When someone with HIV is taking NRTI drugs, the enzyme cannot properly convert RNA to DNA, which slows the progression of HIV. The Food and Drug Administration (FDA) has approved the following NRTIs:
abacavir (Ziagen) emtricitabine (Emtriva) lamivudine (Epivir) tenofovir alafenamide (Vemlidy) tenofovir disoproxil fumarate (Viread) zidovudine (retrovir)
In most cases, HIV treatment combines two or more NRTIs. The Ministry of Health and Human Services notes that some common combinations include:
abacavir plus lamivudine (Epzicom) abacavir plus lamivudine plus zidovudine (Trizivir) lamivudine plus zidovudine (Combivir) tenofovir alafenamide plus emtricitabine (Descovy) tenofovir disoproxil fumarate plus emtricitabine or lamivudine (Truvada or Cimduo)
Usually, a doctor will perform a drug resistance test to determine if NRTIs are likely to work. They may also consider prescribing other medications if a person is pregnant or has other conditions along with HIV. Most NRTIs come in pill form. However, young children who cannot swallow can take liquid forms of the medication. Health professionals will likely start a person with HIV on a treatment plan with one or two NRTIs in addition to another antiretroviral drug. Although it is safe to take NRTI with or without meals, it is always important to take it as directed by your doctor. A person should avoid skipping any doses, as HIV can spread and develop resistance to NRTIs. Most medications, including NRTIs, can have side effects. Although these side effects are often mild, they can be persistent. A person should consult a doctor if they have any concerns about the side effects they are experiencing. The doctor can discuss with them how to manage the side effects or change their prescription to another NRTI. Some common side effects of multiple NRTIs include: Although uncommon, NRTIs can also cause:
accumulation of lactic acid in the blood liver problems pancreatitis skin changes such as discoloration
Allergic reactions
Some people may experience severe allergic reactions to abacavir. This response is common among people who have a genetic variant called HLA-B * 5701, which doctors can detect through a blood test. A person should talk to a healthcare professional if they experience the following symptoms while using abacavir:
fever skin irritation or rash nausea, vomiting or diarrhea breathing difficulty
A 2018 article states that the reactions from abacavir are severe and can be fatal. Because of this, a doctor may consider other options. Some research suggests that abacavir may increase the chances of heart disease, such as heart attacks, especially among those with cardiovascular risk factors. Although more research is needed to confirm this, people with known risk factors for heart disease should discuss this with a doctor before taking abacavir.
Other side effects
Tenofovir disoproxil fumarate may cause kidney problems and loss of bone density. Tenofovir alafenamide is a standard replacement NRTI for people who have experienced the above side effects using tenofovir disoproxil fumarate. Although it is safer for bones and kidneys than tenofovir disoproxil fumarate, it can increase body weight. Zidovudine can cause anemia and lipodystrophy. It can also lower white blood cell counts, increase lipid levels or cause muscle weakness, in rare cases. A person should seek immediate medical attention if they experience any of the following symptoms while taking NRTIs:
skin rash fast breathing jaundice stomach ache vomiting bloated stomach a feeling pins on the legs or arms
HIV is a viral infection that a person can cure and manage well if diagnosed at an early stage. Doctors use antiretroviral drugs to control HIV. NRTIs are a class of drugs that prevent the virus from copying itself and invading the bloodstream. Taking over-the-counter medications will help control the condition and reduce a person’s risk of developing AIDS. People should seek medical attention immediately if they notice any side effects while taking HIV medication.
