Treatment

What treatments exist for HIV infection and what are their impacts?

Several different types of medicines exist to treat HIV infection. These medicines attack various aspects of the process used by the virus to replicate itself. Because HIV quickly mutates to become resistant to any single drug, patients must take a combination of medicines to achieve maximum suppression of HIV.

The combination of medicines for therapy is known as antiretroviral therapy; some people use the term ARV (antiretroviral) treatment. Antiretroviral medications or drugs are used to treat children and adults infected with HIV, to prevent transmission of HIV from mother-to-child, and as a preventive therapy after exposure to HIV infection [also called post-exposure prophylaxis]. Starting antiretroviral therapy early in the course of HIV infection in infants and children has also led to significant positive changes in the survival of children living with HIV.

Antiretroviral therapy changes the natural course of HIV infection, significantly delaying the development of symptoms. To achieve this, it is important to diagnose HIV infection early in order to initiate therapy before AIDS symptoms develop, although patients who start on therapy even after being diagnosed with AIDS often receive major and long-lasting health benefits.

Although antiretroviral therapy is effective in slowing the progression of HIV-related disease and can prolong one's life up to a normal life expectancy, it is not a cure, and a person may still develop AIDS one day. Antiretroviral therapy should not be disrupted and needs to be taken for life. Any exception to this should be carried out in consultation with a specialised medical doctor based on the individual case. In addition to treatments for HIV infection itself, therapies exist to prevent and/or treat many HIV-related opportunistic infections.

As a result of medical advances, people living with HIV are now able to live with the virus, healthily and productively.

As staff of the UN, we (and those in our families who are also covered by UN-related insurance) are entitled to appropriate medical care, including HIV-related care. Please take note that if you are living with HIV, before you get treatment, it is helpful to become aware of the variety of existing treatments. Each treatment needs to be adapted to your personal health situation. It is helpful for you to become an educated partner for your medical doctor when discussing what kind of antiretroviral therapy would be best for you.

If I test HIV-positive, does this mean that I'm going to get sick soon?

You will not necessarily get sick soon if you test HIV-positive.Even in the absense of treatment there is normally a long period after infection before any symptoms of HIV-related diseases appear. As a result of medical advances, people living with HIV are now able to live healthily and productively with the virus. In addition, an extraordinary amount of research is underway to identify treatments to build on those that already exist. HIV infection is a major medical condition that must be taken seriously, but it is not a death sentence.

If I'm HIV-positive and my physician prescribes medication for my condition, can I begin anti-retroviral treatment slowly-say, by taking only one pill at a time?

Because HIV is constantly mutating, it quickly becomes resistant to any single medicine. When resistance develops, the medicines are not as effective and the viral load level in the blood begins to rebound. To prevent or slow down the development of such resistance, your doctor will prescribe three different antiretroviral medicines (combination therapy), although many combination therapies are now available in a single pill. By attacking HIV in different ways, combination therapy achieves maximum impact and reduces the likelihood that drug resistance will develop.

Combination therapy sounds complicated. How can I make sure I am able to adhere and take my medication as prescribed?

Combination HIV therapy is not simple, however with single pill dosing, incorporating as many as three medicines in a single pill, it is getting easier.

Those of us who are HIV-positive and on therapy might need to take multiple drugs especially if our HIV infection is advanced and we also need treatment for other opportunistic infections. Taking medication as prescribed is often referred to as 'treatment adherence'. Because treatment adherence is so critically important in the case of HIV, extra care must be taken to make sure that HIV medicines are taken exactly as prescribed. If you miss doses, fail to take them on time, or otherwise vary your treatment regimen, the medicines will not be as effective and resistance will develop more quickly. Depending on your regimen, you may have certain eating restrictions (such as the need to take medicines with food) and may have to refrigerate one or more of your medicines.

It is a good idea for those of us who are living with HIV and who are prescribed a combination medication regimen to create a personal treatment adherence plan. The nature of this plan will depend on your individual treatment regimen and on the dynamics of your life. Before you leave your doctor's office with your new treatment regimen, discuss your treatment adherence plan with a doctor, nurse or counsellor in order to determine how you can make it work in your life.

The following are some ideas for treatment-adherence:

  • Create a daily calendar to work treatment into your daily routine.
  • Use a daily or weekly planner to keep up with the treatment schedule.
  • Use a beeper or alarm clock to remind you when it is time to take a dose.
  • Count on friends, family members, or roommates to help you remember.

Developing a treatment adherence plan requires that you make a commitment and stick to it. It requires you to look at your life honestly and identify things that might interfere with your ability to take your medicines on time. Even if at times your life becomes disordered, as everybody's does, it is important to maintain some routine to keep to your treatment adherence goals. If you travel, be sure to make note of time differences so that you are able to maintain taking your medicines on time. If you forget to take a dose, take it as soon afterwards as you remember, unless it coincides with the next dose, in which case only take the one dose.

Those of us who are HIV-positive should remember that we are not the only ones facing these challenges, and that others can help. A lot of other people living with HIV or other chronic illnesses are in the same situation. It is important to believe that the treatment is of benefit rather than seeing it as a part of "being sick". One HIV specialist has referred to antiretroviral therapy as "carrying around a million dollar check" because we know that when started at the right time, antiretroviral treatment does prolong people's lives and gives people living with HIV a chance at a normal life expectancy. Discussing treatment with other people facing similar situations may also be helpful, in order to share ideas and find workable solutions for treatment adherence and other issues.

I understand that having HIV can make you susceptible to other infections. If I'm HIV-positive, how can I protect myself from them?

For those of us who are living with HIV, we are most prone to infections once the virus has seriously damaged our immune system. For most individuals, combination HIV therapy significantly strengthens the immune system and reduces susceptibility to opportunistic infections. If you are living with HIV, regularly see a doctor qualified to treat HIV-related illness, so that your immune system can be monitored. Routine monitoring of your immune system will enable your doctor to prescribe treatments to prevent some of the opportunistic infections that can affect people living with HIV.

The susceptibility of people with HIV to opportunistic infections underscores the importance of knowing one's HIV status. Many people with HIV who delay testing only learn that they are positive when they experience a serious, sometimes life-threatening, illness. By knowing your HIV status, you can take better care of your health and ensure that you are monitored periodically. If you are living with HIV, your doctor can prescribe medication that can prevent opportunistic infections from developing.

Preventing, diagnosing and treating tuberculosis

Tuberculosis (TB) is a common and often deadly infectious disease that can affect us all. One third of the world's population is infected with the tuberculosis germ. Not everyone who is infected will develop tuberculosis (only about one in ten in their lifetime) but around 9 million people worldwide who have been infected develop tuberculosis each year.

People living with HIV are much more likely to develop tuberculosis once they are infected (about one in ten per year), even when taking appropriate treatment for HIV. In fact, tuberculosis is the most common cause of illness and death among people living with HIV in many parts of the world, despite being preventable and curable. In many countries, tuberculosis is often the first sign that someone is infected with HIV, as it occurs early in the course of HIV infection.

We must all be aware of the symptoms of tuberculosis and take prompt action if we suspect tuberculosis in ourselves or our colleagues, friends and family. Early diagnosis and treatment of tuberculosis improves the outcome and reduces the risk of spreading it to others. The most common symptoms of tuberculosis are persistent cough for more than two to three weeks, unexplained weight loss, fever, and night sweats. If you think you might have tuberculosis, visit your nearest clinic immediately.

All of us who are living with HIV should be screened to see if we have been infected with tuberculosis, as this can be treated to prevent tuberculosis disease developing (isoniazid preventive therapy). People living with HIV should also be screened regularly for tuberculosis disease each time they go to the clinic. Remember, tuberculosis is preventable and curable.

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More Information

To find out more information about the HIV life cycle and treatment options, visit the following sites (pages will open in a new browser window):

  • AIDS Treatment News
    This site by AIDSNEWS.org includes hundreds of links about treatment issues, and is divided up into usable categories, like, ‘Medical Journals Online,’ ‘Ask an Expert,’ ‘Women, Children and Families,’ ‘Alternative Therapies and Buyers’ Clubs’.
  • Currently Approved Drugs for HIV: A Comparative Chart
    A summarized chart about AIDS medication by Aidsmeds.com.
  • National Aids Treatment Advocacy Project
    The website of an American based organization focusing on AIDS treatment.
  • Community AIDS Treatment Information Exchange
    CATIE, a Canadian non-profit organization, provides AIDS treatment information (symptoms, diagnostic, prevention, access to medication, research...) in an effort to encourage people living with HIV and AIDS to get actively involved in making decisions and developing strategies to optimize their health care. A comprehensive Web site, with two electronic mailing lists, numerous current print publications and a bilingual, and a toll-free phone service.
  • Anti-retroviral Therapy
    A very useful site for HIV + individuals by the University of Liverpool.
  • Database of Anti-retroviral Drug Interactions
    This site was developed by HIV Insight, a site developed by the University of California at San Francisco Medical School.