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Dr. Jim Shelton's Pearls "Pearl" for the week of March 17, 2004

First Line ART: 2 Nukes + 1 Non-Nuke

We're starting to get involved with providing antiretroviral therapy (ART). 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 two nucleoside reverse transcriptase inhibitors (NRTIs) plus one non-nucleoside reverse transcriptase inhibitor (NNRTI) (see below). (Sometimes categorized as "two nukes and a non-nuke".) Each of the four recommended regimens contain Lamivudine, plus one of the other NRTIs and one of the two NNRTIs.

Leading Nucleoside Reverse Transcriptase Inhibitors

Zidovudine(ZDV)

Stavudine(d4T)

Lamivudine(3TC)

Leading Non-nucleoside Reverse Transcriptase Inhibitors

Nevirapine(NVP)

Efavirenz(EFZ)

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

The 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 web site on antiretroviral therapy.

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

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)

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development, the U.S. Government or The Johns Hopkins University.