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Treatment

Drug Treatment

HIV causes a person to become more prone to illness, so infected people need treatment options. However, there is no cure for HIV. To help ease negative symptoms, drugs called anti-retroviral therapy (ART) are available. This treatment is also called high active anti-retroviral therapy (HAART). HAART treatment begins with one non-nucleoside reverse transcriptase inhibitor (NNRTI) and two nucleoside analogue reverse transcriptase inhibitors (NRTIs). The NRTI drug could be named zidovudine (AZT), tenofovir (TDF), andlamivudine (3TC), or emtricitabine (FTC).

These drugs slow the progression of the HIV virus in the body. Usually, these treatments consist of a combination of three or more drugs, and each drug performs a different job in fighting the virus. In general, HAART prevents the HIV from multiplying and destroying CD4 cells. CD4 cells are necessary to help protect the body from infections and cancer. Since the HIV virus destroys CD4 cells, it causes people with HIV to be more prone to illness.

It is recommended to start HAART if a person has HIV and has a CD4 cell count of less than or equal to 350 cells/mm3. This number can be determined by a doctor. A person’s age, sex, and other infections determine which treatment he or she should take. These medication regimens can help HIV-infected people live longer, healthier lives, and can also help prevent the HIV from advancing to AIDS. Below, Table 1 shows the exact recommendations.

Current Guidelines

Table 1

Target Population	Preferred options	Comments
Adults and adolescents	AZT or TDF + 3TC or FTC + EFV or NVP	Select the preferred regiments applicable to the majority of PLHIV. Use fixed-dose combinations.
Pregnant women	AZT + 3TC + EFV or NVP	Do not initiate EFV during first trimester. TDF acceptable option.
HIV/TB coinfection	AZT or TDF + 3TC or FTC + EFV	Initiate ART as soon as possible (within the first 8 weeks) after starting TB treatment. NVP or triple NRTIs are acceptable options if EFV cannot be used.
HIV/HBC coinfection	TDF + 3TC or FTC + EFV or NVP	Consider HBsAg screening before starting ART, especially when TDF is not the preferred first-line NRTI. Use of two ARVs with anti-HBV activity required.

Symptoms of acute HIV infection

When to start therapy

Immediate Treatment

If a person has been exposed to HIV, it is recommended to begin receiving HAART as soon as possible within 48-72 hours of exposure. This immediate treatment method is called Nonoccupational Postexposure Prophylaxis (nPEP). nPEP can reduce the risk of transmission of HIV after exposure to body fluids that could be harmful. These body fluids are most frequently blood or semen. This treatment is a 28-day drug regimen. The fast start of nPEP with HAART is recommended if the patient seeks care within 72 hours after exposure, if the source is known to be HIV infected, and if the exposure event presents a substantial risk for transmission. This treatment is not recommended if the patient seeks care over 72 hours after exposure.

General Treatment

There has been controversy surrounding when the correct time to start therapy should be after a person discovers that he or she has HIV. Recently, the answer has been that earlier treatment is recommended. This is because, first, effective therapy can prevent non-AIDS-related deaths. Second, therapy can prevent harm to a person’s immune system. Third, therapy can help prevent transmission of HIV to others, and can therefore reduce HIV prevalence overall. Although there are some negative side effects of antiretroviral medications, the benefits of therapy usually outweigh the negative effects.

Effects of therapy

Patients on HAART have reported significant improvements in physical health, emotional health, mental health, and daily function compared to HIV-positive patients not yet on treatment. Most research has occurred in developing countries, and little research has been done on the impacts of ART on household wellbeing.

Although HAART can be an effective means to treating HIV, there can be many negative side effects. Negative side effects can vary by drug, by ethnicity, and by drug interactions in the body. The following list contains the most common and serious negative side effects associated with HAART medications to treat HIV.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

• Lactic acidosis, hepatic steatosis, and body fat redistribution (lipodystrophy)
• Fever, headache, rash, nausea, vomiting, diarrhea, fatigue

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• Rash, Stevens-Johnson syndrome, and toxic epidermal necrolysis
• Fatigue, mood changes, liver function, insomnia
• May have significant interactions with other drugs; dosage adjustments would be required

Protease Inhibitors (PIs)

• Metabolic abnormalities including dyslipidemia, hyperglycemia, insulin resistance, and lipodystrophy
• May increase risk of bleeding in hemophiliacs
• Rash, diarrhea, vomiting, taste perversion, fatigue
• May have significant interactions with other drugs; dosage adjustment would be required

Fusion Inhibitors

• Injection site reactions, neutropenia, increased frequency of pneumonia

Chemokine Coreceptor Antagonists

• Diarrhea, nausea, fatigue, dizziness, headache, liver function, joint pain

Integrase Inhibitors

• Nausea, diarrhea, headache, rash

Pharmacokinetic Enhancers

• Increased serum creatinine, proteinuria, nausea, diarrhea

Alternative therapy

Many people living with HIV have tried using alternative treatment methods, known as complementary and alternative medicine (CAM). Some types of CAM include stress management, natural health products, massage/therapeutic touch, acupuncture, and homeopathy. Stress management can increase quality of life for a person with HIV. Even with little evidence of its effectiveness, many people chose to try CAM because of the many negative side effects associated with HAART and the few negative side effects associated with CAM. Some HIV-infected people also try herbal medicines to treat HIV, but there has been no evidence showing any positive outcomes with the use of herbal remedies.

Another type of alternative therapy for treating HIV is micronutrient supplementation. Micronutrients are vitamins and minerals, so these supplements would be in the form of a general daily multivitamin. These supplements have been proven to help treat HIV because HIV can cause micronutrient deficiencies, so the supplements can help replenish these needed vitamins and minerals. Although the supplements may not help ease all negative symptoms, they offer some benefits and are safe for HIV-infected patients. Supplements are also safe for HIV-infected pregnant women and their children. Specifically, vitamin A and zinc have shown positive health effects. There are no major negative side effects of vitamin and mineral supplements.