Treating HIV/AIDS

HIV Treatment Basics

Advances have been made in treatments for HIV/AIDS that have made HIV a manageable disease. There is no cure at this time. It is not known exactly how long the medications will extend life, but many people living with HIV who receive appropriate treatment are already living into old age. Someone who is diagnosed with HIV before the virus has done severe damage to the immune system and who is started on HIV treatment early would be expected to have a nearly normal lifespan. Here are some basic points to keep in mind:

  • HIV treatment is now strongly recommended for all people living with HIV whether their immune system is strong or weak.
  • HIV treatment is much simpler and easier than it was 20 years ago. Most people newly diagnosed with HIV can take “one or two pills, once per day” and keep their HIV under control.
  • Today’s preferred HIV treatments tend to be well-tolerated and much less toxic to the body than older treatment regimens. Like most medications, HIV treatments can still cause side effects, but they are usually manageable and often dissipate after a few weeks. Side effects like abnormal fat distribution, anemia, and neuropathy are not common with the treatments we use most today.
  • HIV treatment stops HIV from being able to reproduce in the body, so it decreases the amount of virus circulating in the body. This prevents damage to the immune system, but also means that it is much less likely for HIV be transmitted to others.
  • HIV treatment works best if it is taken every day as prescribed. If someone living with HIV frequently misses doses, HIV can mutate (change its genes) and develop resistance to HIV treatments much like some bacteria can develop antibiotic-resistance. If the virus develops drug resistance, it can make HIV treatment more complicated and difficult.
  • HIV medications are expensive, but there are multiple programs that can help cover the costs of medications or insurance copays for people living with HIV.

HIV Treatments

Effective HIV treatment means using a combination of medications that are active against HIV to reduce the levels of HIV in the body. HIV treatment is often referred to as

Antiretroviral Therapy (ART) or 

Highly Active Antiretroviral Therapy (HAART) or

Antiretrovirals (ARVs)

ART stops HIV from reproducing in the body, which does a number of things, such as

  1. Helping to prevent damage to the immune system. For many people, ART can actually reverse damage that HIV has already done to the immune system.
  2. Reducing risks for heart disease, cancer, kidney disease and other long-term health problems caused by chronic HIV. For a number of reasons, HIV increases a person’s long term risk for developing health problems like heart disease, cancer, and kidney disease. Keeping HIV suppressed (under control with medications) helps to mitigate the excess risk due to HIV.
    • Some (but probably not all) HIV medications may independently increase the risk of some heart or kidney problems, though the benefit of keeping HIV under control usually outweighs those risks and the medications known to cause these issues can often be avoided for someone with other traditional risk factors for heart or kidney disease.
  3. Reducing the amount of detectable virus in blood and sexual fluids, which reduces the risk of transmitting HIV to others.

What it can do

  • Antiretroviral therapy can increase life expectancy.
  • Antiretroviral therapy can make an HIV-positive person feel healthier and can reverse some conditions and symptoms caused by advanced HIV. For example, someone who has experienced weight loss or skin problems due to untreated HIV may see an improvement in these symptoms after starting HIV treatment.
  • Antiretroviral therapy can prevent and even reverse damage already done to the immune system by untreated HIV.
  • Antiretroviral therapy can greatly reduce the risk of transmitting the virus to others if taken daily as prescribed.

What it cannot do

  • Antiretroviral therapy does not cure HIV/AIDS. If an HIV-positive person stops taking their antiretriviral therapy, the virus will start reproducing in the body again and levels of the virus will rebound.
  • Antiretroviral therapy can reduce the risk, but is not known to completely eliminate the risk of transmitting HIV to others.
  • In some cases, antiretroviral therapy for HIV will not make a person feel better. An HIV-infected person who feels well and does not have symptoms of HIV might feel worse on antiretroviral therapy because of side effects, such as nausea or headaches. Nevertheless, it is important to keep in mind that antiretroviral therapy has many long term benefits for the health of an HIV-positive person, even if they are not yet experiencing symptoms or infections from HIV.

Drug Resistance and Importance of Sticking to Drug Therapy Routines:

HIV can develop drug resistance, much like bacteria can develop antibiotic resistance. If resistance develops, it makes treating HIV more difficult and complicated.

In order for antiretroviral therapy to remain effective, it is crucial for a person to stick to a medication routine, which normally means taking antiretroviral medications at the same time every day. Missing doses of medications too frequently can enable HIV to mutate into a drug-resistant strain that may not be effectively treated by the medication.

  • Some medications are more forgiving of missed doses than others (that means it is harder for HIV to mutate and develop resistance to some medications); however, sticking to a routine is always the best way to ensure that antiretroviral therapy remains effective.
  • When HIV develops resistance, that resistant virus can be transmitted to others sexually or through blood-to-blood contact. For this reason, someone who is newly diagnosed with HIV and has never been on antiretroviral therapy may find that their strain of HIV already has drug resistance. Likewise, someone with HIV can acquire new drug resistant virus by having condomless sex with another HIV-positive person who has a resistant strain of virus.
  • There is a blood test called a HIV genotype resistance assay that can analyze the genes of a patients HIV strain and provide their provider with a report of any mutations that may be present. This helps providers tailor an antiretroviral therapy regimen to an individual’s virus.

Opportunistic Infections

Opportunistic infections (OIs) are infections that occur more frequently in people with damaged/weak immune systems and are unusual in those with normal immune systems. Examples of OIs that are seen in people living with AIDS include:

  • Pneumocystis jarovecii pneumonia (PCP)
  • Tuberculosis (TB)
  • Invasive cervical cancer
  • Yeast infection in the throat or esophagus
  • Herpes sores that don’t go away for more than a month
  • Histoplasmosis
  • Kaposi’s Sarcoma (KS)

Preventing Opportunistic Infections

A T-Cell or CD4 cell count is a blood test that helps measure the strength of a person’s immune system. One of the main reasons we monitor the T-Cell or CD4 Count in patients living with HIV is to know if opportunistic infections might become more likely. If the CD4 Count declines, especially if it drops below 200 cells per microliter, infections become more common and medications should be used as prophylaxis to prevent them. If a person’s CD4 Count increases on antiretroviral therapy, then prophylaxis can often be stopped. Medications used for prophylaxis, which means they prevent of infections before they start, can be antibiotics or antifungals or sometimes antivirals.

Someone who is diagnosed with AIDS and has a low CD4 count should be encouraged to start on both antiretroviral therapy to control HIV and help reverse damage to their immune system and prophylaxis for the prevention of opportunistic infections.