Treatment Options for HIV
HIV attacks the Cluster of Differentiation 4 (CD4) T cells that help make up your immune system. The lower your CD4 T count gets, the more susceptible you are to other illnesses, like recurrent pneumonias, certain fungal infections and cancers.
Once the CD4 T count falls low enough -- usually below fifty (a normal CD4 T count is above 500) -- it’s considered Acquired Immune Deficiency Syndrome (AIDS), the end-stage version of an HIV infection. Unlike HIV, AIDS is usually fatal.
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An HIV diagnosis is an understandably scary prospect but not the death sentence it used to be. Modern medicine has come a long way, and there are effective treatments to keep the virus at bay. In general, unfortunately HIV cannot be cured, and treatment is a daily commitment for the rest of your life. But, if followed correctly, HIV is like any other chronic disease you have to manage. And if managed well, there is no reason you won’t live a long, healthy and normal life.
As soon as you learn you’ve tested positive for HIV, make plans to go see a specialist in infectious diseases. If your doctor recommends it, and you feel you’re ready, you should start taking anti-HIV treatment, also called antiretroviral therapy (ART). In order to treat HIV, you need to have three active antiretroviral drugs 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); or Integrase inhibitors.
That’s a fancy way to say all these drugs work in sync with one another to keep you healthy. Thankfully, nowadays in many cases you can get all three medications in one pill.
Sticking With It
There are several determinants for your particular HIV regimen, and perhaps the most important of all is the decision and willingness to fully commit to treatment. It is essential to take every single pill every single day. Unlike treating diabetes, blood pressure or other chronic conditions, failing to take your pills for even just a day could cause your virus to become resistant to the treatment permanently. In fact, it’s better to take no treatment at all than to take it poorly. Once the first-line treatment combination becomes ineffective, your regimen will only become more difficult due to the increased side effects and decreased effectiveness of some of the older treatment options.
Because of the increase in the number of medications available, there are other options if the treatment doesn’t work or if a particular treatment causes side effects you can’t tolerate. And though we have more treatment options today, they’re still limited because you have to remain on medication every day for the rest of your life, and missing just one day can cause your virus to become resistant to that specific treatment -- which means you’d have to switch to a different one.
Trial and Error
Another determinant for your HIV regimen is your toleration for its side effects. Your initial anti-HIV medication cocktail, as it’s sometimes called, may cause intolerable side effects like diarrhea, rashes, nausea and vomiting. There may also be psychiatric effects, such as mania, vivid nightmares, and worsening of any pre-existing mental illness, which in a few cases could outweigh the benefits of the treatment.
Any pre-existing conditions could have an effect on which drug cocktail you can take as well, especially if the medicine you are already taking to treat other conditions reacts negatively with the ART. There’s also the chance that prior medication could create an underlying resistance to your initial HIV regimen. And sometimes, the treatment just won’t work; either it won’t be effective right away, or it drops in effectiveness after initially working.
The Bright Side
If you have side effects with the program, if for whatever reason it interacts with some other medications, or it’s simply not working, then we’ll switch to other medications. The vast majority of patients, however, will take one of these first line programs and do very well. Although undetectable in the blood on the right treatment, HIV will still remain in your body, and you can still transmit the virus to others. But as long as you are committed to taking your medication every day, your CD4 T cells will have a fighting chance to keep you as healthy as possible. In fact, it’s expected that today’s generation of individuals who are HIV-positive will live a full life, with a near normal life expectancy.
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 >