treatment-experienced HIV
Treatment for human immunodeficiency virus (HIV) is ongoing and consists of various antiviral medication combinations (antiretroviral therapy).

There is still no cure for the human immunodeficiency virus (HIV) because no treatment can completely eliminate the virus from the body. Treatment approaches prevent the virus from multiplying in the body and causing sickness apart from reducing the likelihood of the spread of infection to others.

Treatment is ongoing and consists of various antiviral medication combinations (antiretroviral therapy or ART). Starting ART timely reduces the progression of HIV and can keep you healthy for many years.

The goal of treatment:

  • The World Health Organization guidelines recommend that all people with newly diagnosed HIV be referred to a specialist and begin treatment (ART) as soon as feasible, regardless of CD4 cell levels (a type of immune cell) or symptoms.
  • The individual infected with HIV should be included in the decision to begin therapy.
  • The primary goal of ART is to limit HIV replication as much as possible.
  • The second goal is to allow the immune system to heal and prevent the development of myriad infectious and cancer-related issues that people with acquired immunodeficiency syndrome (AIDS) experience.

HIV drug therapy

  • Treatment is often based on triple therapy (although more than three medications may be given) or highly active ART, which consists of two or three medications from the class known as reverse transcriptase inhibitors (RTIs), combined with a protease inhibitor.
  • Antiretroviral medication is quite effective, but it must be taken for the rest of the person’s life, so people must adhere to the treatment plan as prescribed by their doctor.
  • Antiretrovirals are generally well tolerated and rarely cause side effects. If the person has a poor tolerance for the medicine, it should be changed to an HIV medication the person tolerates well. 

Antiretroviral medications are classified based on the stage of the virus replication cycle that they affect.

Four types of ART include:

  1. RTIs:
    • RTIs work by inhibiting the HIV enzyme (reverse transcriptase), which helps form viral DNA from viral RNA, which is then incorporated into the DNA of human CD4 cells.
  2. Protease inhibitors:
    • Protease inhibitors are extremely effective against HIV, and their activity occurs at a late stage in the replication cycle.
    • They block the protease enzyme, which HIV utilizes to cleave new protein chains that form inside the infected human cell into pieces to assemble new viral particles.
  3. Entry inhibitors:
    • These medications keep HIV from infiltrating CD4 cells.
  4. Integrase inhibitors:
    • This class of medications prevents the HIV genetic material from integrating into the genetic material of an infected human cell.

QUESTION

What is HIV? See Answer

HIV psychological treatment

  • Psychological support is essential for assisting people with HIV in dealing with the various scenarios that may arise, particularly concerning complex treatment.
  • A comprehensive strategy to treat the infection improves the person’s quality of life.
  • Nongovernmental organizations can give free specialized psychological support and social care.
  • One of the primary characteristics of community programs and services is that they support society's most disadvantaged individuals.
  • This is done in a welcoming and safe setting, where a beneficial link is established to provide psychosocial support and complete services such as assistance with adjusting to a new situation, health promotion, and knowledge about the person’s rights as a user.

HIV vaccination

  • Currently, no vaccinations are available to prevent HIV infection.
  • The most pressing issue that needs to be addressed is the development of effective anti-AIDS vaccinations.
  • Vaccination is our best option for eradicating HIV infection. However, due to HIV's adaptation and escape mechanisms for evading the body's immune response, as well as difficulties involved in creating, deploying, and evaluating prototype vaccines, it is a tough scientific undertaking.

Most HIV treatment tries to inhibit the virus's reproduction and, as a result, the virus's attack on white blood cells (immune cells).

Several biochemical processes are required for the virus to enter the white blood cells, grow and finally escape the cells to infect new ones. HIV medicine either prevents or interferes with these processes.

HIV treatment uses various attack techniques to keep HIV from multiplying. Some treatments prevent the virus from entering immune cells, whereas others destroy or prevent the virus from reproducing within immune cells or prevent it from exiting in a form that might infect new cells.

What are the risks and side effects of HIV treatments?

Risk of mutation and resistance development in the virus is the common risk associated with human immunodeficiency virus (HIV) treatments.

Mutation

  • HIV is capable of rapidly multiplying and producing new “versions” of the virus that differ slightly from the original, a process is known as mutation.
  • This means that a person with HIV will eventually have many distinct versions of the virus, but none may be created in sufficient quantities to completely replace the original virus.

Resistance

  • The original virus will be inhibited by HIV medication when therapy begins. When only one medicine is used in the treatment, a mutation that can survive it may arise.
  • The modified virus will be able to bypass the HIV drug's “attack.” Viruses will continue to multiply and eventually outnumber the original virus.
  • Treatment will no longer be effective, which is referred to as resistance.
  • When two medications are taken at the same time, the likelihood of resistance development is reduced.
  • The more drugs that are delivered, the lower the probability of resistance developing.
  • As a result, a “cocktail” or combination of different medications is frequently administered concurrently.

The goal of treatment is to develop a medication combination that reduces the viral load to undetectable levels and maintains it there. The risk of additional mutations and resistance is then minimal.

Correct HIV medication use is usually highly efficient in avoiding the formation of new viruses and lowering the danger of HIV mutations. This, however, necessitates that the virus is constantly “bombarded” with medications that inhibit the reproduction process. As a result, it is critical to take HIV medication on a strict schedule and in the correct dose every day.

Side effects of treatment

Adverse effects of HIV medication might differ from one drug to the other and from one person to the other. With many of today's HIV medications, it is feasible to discover a treatment that has few adverse effects for the individual.

HIV medication side effects may be deemed problematic or may only be noticed through blood sample monitoring and may include:

Some side effects may cause damage to:

  • Bone marrow
  • Kidneys
  • Liver and pancreas

The risk of cardiovascular disease and diabetes might sometimes be increased by side effects. Furthermore, HIV infection may increase the risk of such disorders. Routine checkups are, therefore, necessary, both to monitor the effect of medication and to assess any side effects.

  • Therapy used to treat diseases other than HIV can have side effects that amplify or hinder the effectiveness of HIV medicine.
  • HIV medicine can affect the treatment of other diseases.

SLIDESHOW

A Timeline of the HIV/AIDS Pandemic See Slideshow

HIV follow-up during treatment

  • The viral load in the blood and CD4 cells, as well as virus resistance testing, are used to monitor treatment.
  • If severe adverse effects occur, drug combinations can be changed to make the treatment more tolerable.
  • After 12 weeks, the goal of treatment is to have a viral load of less than 500 virus copies/mL and less than 50 virus copies/mL after 24 weeks.
  • The development of resistance is mainly caused by failure to take medications as prescribed by the doctor.

How is the outlook of people with HIV?

If you are diagnosed with human immunodeficiency virus (HIV) and begin antiretroviral therapy (ART) in the early stages of the disease, your immune system will be less weakened. If you continue to take your medications daily, your prognosis is quite excellent.

Although ART can maintain virus levels undetectable, it cannot eliminate the body of the virus (which remains inactive in your cells). If you do not take your prescribed medications on time, the virus will reenter your bloodstream.

  • If you have HIV and do not treat it, it can take up to 10 years before you develop acquired immunodeficiency syndrome (AIDS). If you have AIDS and do not treat it, you have about a three-year survival rate.
  • It is critical to understand that people with HIV who follow treatment guidelines can live complete lives for nearly as long as HIV-negative people.
  • If you believe you have been exposed, contact your healthcare practitioner right away so that you can be tested. If you have HIV, you should start treatment as soon as possible.
  • There is post-exposure prophylaxis (PEP), which should begin within 72 hours of suspected exposure. This entails receiving ART following the exposure to infection.
  • PEP may be prescribed if you believe you have been exposed during sex or drug use.

The most important aspect of controlling AIDS is to continue taking your medications and to fight off opportunistic infections (infections that occur in people with compromised immunity) at the first sign of them.

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Medically Reviewed on 3/25/2022
References
Image Source: iStock Images

What is HIV treatment? https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html

HIV Treatment: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-basics

HIV treatment: https://www.unaids.org/en/topic/treatment

Treatment Decisions for HIV: Entire Section: https://www.hiv.va.gov/patient/treat/decisions-single-page.asp

RESEARCH AND TREATMENT: https://www.publichealth.org/public-awareness/hiv-aids/research-treatment/