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23 November, 2009

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HIV treatment

Drug treatments for HIV offer many people the chance to control the virus and stay healthy for much longer. Treatment options have had a huge impact on the lives of people with HIV and those who care for them. They can reduce AIDS-related illnesses, admissions to hospital and death rates. Treatment has also enabled some people with HIV to go back to work and plan for the future.

HIV drug treatment is known as combined antiretroviral therapy (CAR) or, sometimes, highly active antiretroviral therapy (HAART). Treatments do not work equally as well for everyone. They can have side effects and some people develop what is called drug resistance. Drug treatment does not prevent transmission of the virus.

Types of treatment
There are five main groups of drugs involved:

Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Nucleotide reverse transcriptase inhibitors
Protease inhibitors
Fusion inhibitors.

Usually, three different drugs from at least two of these groups are taken together, two to four times a day. Some tablets now contain two or three different drugs. The advantage of these combination drugs is that people do not need to take as many tablets each day.

How treatment works
When the HIV virus gets into a body cell, it generally starts to make copies of itself. These copies then spread out of that cell and into another. Drug treatments control the virus by interfering with the chemicals it uses to make copies of itself inside the body cells. The fusion inhibitors stop the HIV binding onto a new cell so it can no longer enter.

Over time, the virus can become resistant to the drugs, which means that they won’t work as well. The treatment may then have to be changed to a different combination of drugs.

People taking drug treatment for HIV will probably need to take it for the rest of their lives. Stopping drug treatment, even for short periods of time, can cause the virus to become resistant to those drugs. It is not recommended that anyone interrupt drug treatment without medical advice.

Drug treatment does not work well for everyone. Even when it is working well, it cannot control all of the virus, so the person will still have HIV in their body.
Treatment does not stop someone with HIV from being able to pass on the virus through unprotected sex or sharing needles or injecting equipment.

The impact of taking HIV treatment
HIV treatment is usually taken in tablet form. The tablets have to be taken at the right times, because missing doses makes it more likely that the virus will become resistant. Some tablets have to be kept in the fridge and some cannot be taken with certain kinds of food. The person with HIV has to be very organised about remembering to take tablets and fitting them in with their meals.

Tablets may have to be taken in public, such as at work. People may feel very uncomfortable about taking tablets for HIV at work. Others may prefer to tell their work colleagues so they can learn a little about HIV and provide support. Some combinations of drugs may be more suitable if they don’t need to be taken during working hours.

Side effects
Some of the most common side effects of HIV treatment are:

Nausea (feeling sick)
Diarrhoea
Tiredness
Difficulty sleeping
Headaches
Peripheral neuropathy (problems with the nerves in the legs, such as pain)
Skin rashes
Lipodystrophy (changes in the way body fat is distributed around the body).

People taking HIV treatment have to go to their doctor at least every three months. They need to have regular blood tests to make sure that the treatment is working and that it is not having serious side effects.

Complementary therapies
Some people with HIV use other types of therapy, either alone or with their drug treatments. It is important to tell your HIV specialist doctor if you are seeking out alternative therapies, as some drugs and treatments may have contraindications or unwanted side effects.

Some of the most popular complementary therapies are:

Vitamin and mineral supplements
Massage
Meditation
Herbal remedies
Traditional Chinese Medicine
Acupuncture.

New drug treatments
New drugs and types of drugs are being developed all the time. Trials of these treatments are being conducted in specialist HIV/AIDS treatment and research centres.

Where to get help

A doctor who specialises in HIV
HIV and Sexual Health Connect Line Tel. 1800 038 125
HIV, Hepatitis and STI Education and Resource Centre, Alfred Health Tel. (03) 9076 6993
Melbourne Sexual Health Centre Tel. (03) 9341 6200, 1800 032 017 or TTY (for the hearing impaired) (03) 9346 8619
Positive Women Tel. (03) 9076 6918
Straight Arrows (heterosexual men, women and children) Tel. (03) 9076 3792
Victorian AIDS Council/Gay Men’s Health Centre (Treatment officer) Tel. (03) 9865 6700 or 1800 134 840
Victorian HIV/AIDS Service, Alfred Health Tel. (03) 9076 6076
Victorian Infectious Diseases Service, Royal Melbourne Hospital Tel. (03) 9342 7212

Things to remember:

Deciding to take treatment is a big lifestyle decision. Spend time to think through the issues.
Discuss treatment with your doctor and with other HIV positive people. Early treatment is recommended.
HIV treatment does reduce AIDS and death rates.
HIV treatment can cause side effects and may be less affective for some people.
Treatment does not prevent the virus from being passed to other people.

You might also be interested in:
Acupuncture.
HIV and AIDS.
HIV and AIDS - infection control in hospitals.
HIV and women - safe sex.
HIV testing.
Sexually transmissible infections - avoid the risk.
Sexually transmissible infections - overview.
Sexually transmissible infections - signs and symptoms.
Sexually transmitted infections in Victoria 2000.

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