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Highly Active Anti-retroviral Therapy (HAART)

The blood supply in the United States is now safer than ever before due to screening, testing, and viral inactivation in donated blood and plasma. In addition, recombinant clotting factor concentrates carry virtually no risk of viral transmission. While these are important advances for the bleeding disorders community, many people who were treated with blood products during the 1970s and 1980s—prior to the implementation of blood screening and treatment standards and the development of recombinant products—were infected with human immunodeficiency virus (HIV).

  • More than 50% of people with hemophilia were infected with HIV.
  • More than 80% of people with severe hemophilia were infected with HIV. (Some estimates are as high as 90% to 95%.)

Highly Active Anti-retroviral Therapy (HAART)

Fortunately, the treatments for HIV have improved dramatically over the past few decades. The standard of care for HIV treatment is highly active anti-retroviral therapy (HAART), also called combination anti-retroviral therapy. HAART involves the use of several drugs at the same time, which are sometimes combined in a single pill. Each drug combats HIV in a slightly different way to stop or delay the virus from multiplying. Generally, HAART includes three or more medications from at least two different drug classes.

There are six classes of drug used to treat HIV:

  • Nonnucleoside reverse transcriptase inhibitors (NNRTIs). These drugs work by binding to and altering reverse transcriptase, an enzyme HIV uses to help make copies of itself.
  • Nucleoside reverse transcriptase inhibitors (NRTIs). These drugs work by blocking reverse transcriptase, an enzyme HIV uses to help make copies of itself.
  • Protease inhibitors (PIs). These work by blocking protease, an enzyme HIV uses to help make copies of itself.
  • Fusion inhibitors. These work by preventing HIV from entering certain cells of the immune system, called CD4 cells.
  • CCR5 antagonists. These agents work by blocking a protein called CCR5, which the HIV needs to enter CD4 cells.
  • Integrase inhibitors. These drugs work by blocking integrase, an enzyme HIV uses to help make copies of itself.

Your healthcare provider or Hemophilia Treatment Center (HTC) team will determine which combinations of medication are best for you, or may refer you to an HIV provider who is expert in HIV management.

When selecting a treatment regimen make sure that they consider:

  • Your bleeding disorder
  • Other diseases or conditions you have
  • The impact of the HIV treatment on other medications you take
  • Whether your body demonstrates resistance to any of the medications
  • The convenience of the regimen
  • Other personal issues that can make following a regimen difficult