Frequently Asked Questions About Starting HIV Treatment
Over the last 30 years, the way we think about and treat HIV has changed drastically. Although it was once thought to be a death sentence, today HIV is a chronic disease that can be successfully controlled with the right treatment.
But despite developments in education and medication, many people still don’t understand the basics of HIV. Infectious Disease Specialist Stacey Rizza, M.D. answers common questions she hears from her patients.
1. Q: What’s the difference between HIV and AIDS?
A: HIV, or human immunodeficiency virus, is the name of the virus that weakens the immune system by killing the Cluster of Differentiation 4 (CD4) T cells, which help the body fight infections. HIV is transmitted through bodily fluid like blood, semen or saliva.
AIDS, or acquired immune deficiency syndrome, is the end-stage, clinical syndrome of the HIV infection. Once the CD4 T cell count has dropped below 50, (a healthy CD4 T count is over 500) and the person is getting opportunistic infections like recurrent pneumonia, or certain fungal infections and cancers, then it’s called AIDS.
2. Q: How is HIV diagnosed?
A: HIV is diagnosed through a blood test by your primary care physician, public health department, gynecologist or obstetrician, or other health organization. In these blood tests, essentially we’re looking for a specific antibody that your body produces to fight the virus.
The antibody usually takes about 2-4 weeks on average to show up on a blood test, so when we’re screening someone for HIV, we check them at six weeks, 12 weeks, and then four months after the potential infection.
Don’t wait until you suspect you’ve been infected to be tested. 20% of people with HIV don’t know they have it. And the Centers for Disease Control and Prevention (CDC) recommends all adults between the ages of 13 and 64 be tested at least once. If you have risk factors for getting HIV, like having frequent unprotected sex, using IV drugs, or past blood transfusions in countries that don’t screen, then you should get tested for HIV at least once a year.
3. Q: How is HIV treated?
A: In order to treat HIV, you need to have three active antiretroviral drugs in your body at all times. Usually, the regimen consists of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), which stop a virus from making copies of itself, and one drug of another class, like protease inhibitors (PIs), which block the protease enzyme and prevent the cell from producing new viruses, Non-nucleoside reverse transcriptase inhibitors (NNRTIs), which block the virus from infecting new cells, or Integrase inhibitors, which prevent the HIV virus from integrating its DNA into your CD4 cells’ DNA. Nowadays, you can frequently get all three therapies in one pill.
With HIV treatment, it’s extremely important to take your medication every single day, because if you miss a day, your virus can develop resistance to the medication and you may have to switch to a medication that may produce serious significant side effects, like vivid nightmares, nausea or vomiting. Before prescribing medication, we make sure our patients are willing and ready to take their pills every single day for the rest of their lives. It’s better to take nothing than to take it poorly.
When I first started my medical career in 1995, there weren’t as many HIV-treatment options. In 1996, when the FDA approved protease inhibitors, it allowed for combination therapy, which meant we could give HIV patients three medications from at least two classes of antiretroviral drugs. That’s when the face of HIV treatment radically changed. Now, so much research is being done on finding a cure, and by just looking at how much has changed with treatment throughout my career, I’m pretty optimistic that we’ll find one within my lifetime.
4. Q: How is HIV monitored?
A: The two numbers that you will hear often after an HIV diagnosis is your viral load and your CD4 T count. The viral load refers to how much virus is replicating freely in your body. The goal of therapy is to get that to undetectable levels, so the disease is “virally suppressed” and our machines can’t detect it in the non-lymphatic, or “peripheral” blood. We know the virus is still hiding away in the lymphoid tissue, liver and spleen which is why, at least at this time, it can’t be cured. The viral load tells you if it’s replicating anywhere else in the blood.
THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
Stacey Rizza, MD, is Chair of the Mayo HIV
Clinic, and Associate Professor of Internal Medicine at the Mayo Medical
School. She has been treating HIV patients since 1998.
View her Healthgrades profile >