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HIV and AIDS TreatmentThere is no vaccine or cure available for people infected with HIV. The disease is primarily treated using prescription antiretroviral therapy. An early diagnosis followed by the appropriate antiretroviral therapy can significantly improve a person's quality of life. Non-drug and alternative treatments help ease the symptoms of HIV and AIDS. Common treatments include: Antiretroviral therapy decreases the incidence of opportunistic infections, slows the progression of HIV to AIDS, and significantly lowers the number of deaths due to AIDS. Unfortunately, antiretroviral therapy must be taken for life. People with undetectable viral counts for several years under treatment will experience an increase in their viral counts soon after they stop taking their medications. The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) recommend providing antiretroviral therapy for all people with HIV-related symptoms. It's not clear when to start treatment. The decision must balance the risk of developing symptoms against the side effects of antiretroviral therapy and the possibility of developing drug resistance. The risk of developing side effects and drug resistance increases over time. Moreover, drug resistance is more likely to develop when people are unwilling or unable to take their medications exactly as prescribed. When drug resistance occurs, antiretroviral therapy becomes less effective or stops working entirely. The current recommendations developed by the Department of Health and Human Services (DHHS) panel on antiretroviral guidelines for adults and adolescents advise therapy for people with HIV who satisfy all of the following: - Advanced HIV symptoms.
- CD4 counts between 200 and 350 cells per cubic millimeter.
- Viral loads greater than 100,000 per cubic millimeter.
- Commitment to taking all of their medications, exactly as prescribed.
Several studies are examining whether or not antiretroviral therapy should be started even earlier. The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications. It's important for people to ask their healthcare provider or pharmacist in advance for possible drug side effects or interactions. Common medications used to treat people infected with HIV include: Antiretroviral DrugsAntiretroviral drugs are grouped into several classes. Each class works differently, and has its own set of side effects and drug interactions. Because HIV drug resistance is more likely to develop when people are treated with a single antiretroviral drug, the recommended treatment for HIV is HAART (highly active antiretroviral therapy). A specific HAART regimen combines three or more medications from different classes of antiretroviral drugs.Although HAART is highly successful, it has several drawbacks: - It's expensive.
- People must reliably take several medications at specific times throughout the day.
- Side effects are common, some of which may be serious.
- The medications must be taken for the rest of a person's life.
There isn't a standard HAART regimen. Each person is prescribed an individual regimen, which is based on the results of their viral load, CD4 count levels, and their general health. As these factors change over time, a person's regimen is altered accordingly. Before starting HAART, people are advised about the possible side effects and drawbacks of the regimen. Throughout treatment, people need to discuss any side effects, new symptoms, and concerns they might have with their healthcare provider. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs/NtRTIs) NRTIs were the first class of antiretroviral drugs available. NRTIs and NtRTIs block the activity of an HIV enzyme called reverse transcriptase, which enables HIV to infect CD4 cells, replicate, and infect other cells.NtRTIs act more quickly than NRTIs. Currently, Viread is the only approved NtRTI. The following NRTIs are listed under combination drugs: Combivir, Epizicom, Trizivir, and Truvada combination drugs: - Emtriva (generic names: emtricitabine, FTC )
- Epivir (lamivudine, 3TC)
- Hivid (zalcitabine, dideoxycytidine, ddC )
- Retrovir (zidovudine, azidothymidine, AZT, ZDV)
- Trizivir (abacavir, zidovudine, and lamivudine)
- Truvada (tenofovir disoproxil fumarate and emtricitabine)
- Videx EC (enteric coated didanosine, ddI EC)
- Videx (didanosine, dideoxyinosine, ddI)
- Viread (tenofovir disoproxil fumarate, TDF)
- Zerit (stavudine, d4T)
- Ziagen (abacavir sulfate, ABC)
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)NNRTIs bind directly with reverse transcriptase enzyme and prevent HIV from infecting new cells. They act more quickly than NRTIs and appear to work in people who are resistant to NRTIs. Protease Inhibitors (PIs)PIs block the enzyme protease, which is used by HIV to replicate (produce infectious copies of itself) within infected CD4 cells. PIs interrupt HIV replication at a later stage. Entry and Fusion InhibitorsEntry and fusion inhibitors are a new class of drugs approved by the FDA in 2003. Both medications work similarly to block HIV from entering and infecting cells. They need to be taken in combination with other medications to lower viral loads and prevent drug resistance. Entry and fusion inhibitors are mainly used in people who have developed resistance to other classes of drugs. Fuzeon is administered by injection. Combination DrugsAs their name implies, combination drugs combine several antiretroviral drugs in a single pill. This reduces the number of pills people are required to take each day. The convenience provided by combination drugs makes it more likely that people will adhere to their treatment regimens. Drug InteractionsTo avoid serious drug interactions, it's important for people with HIV to notify their healthcare team about all medications they're currently using. Antiretroviral medications have been shown to interact with the following medications: - Acid-lowering medications
- Calcium channel blockers
- Cholesterol-lowering medications
- Gastroesophageal reflux disease (GERD) medications
- Herbs such as garlic, milk thistle, and St. John's Wort
- Illegal drugs
- Immunosuppressants
- Medications to treat opportunistic infections
- Migraine medications
- Oral contraceptives
Back to top Several non-drug therapies used in addition to medications can be quite beneficial in improving symptoms and helping people with HIV lead a normal life. Common non-drug therapies for HIV infection symptoms include: AcupunctureAcupuncture attempts to adjust the body's energy flow into healthier patterns by inserting sharp, thin needles into the body.Chiropractic medicineChiropractors attempt to relieve joint stiffness and pain by manipulating the body structures, especially the spine.CounselingAccording to the American Psychiatric Association, people with HIV/AIDS often experience mental health issues, such as acute emotional distress, anxiety, cognitive disorders, depression, and substance use. Moreover, both HIV and antiretroviral drugs can impact a person's memory and thinking. Counseling can help people with HIV and AIDS cope with such issues.Massage therapyMassage therapy helps people with HIV and AIDS relieve chronic muscle tension, and ease their mental and emotional stress.Mind-body therapiesMind-body therapies are designed to help people use their minds to influence the body's ability to fight disease. Mind-body therapies include biofeedback, humor therapy, hypnosis, inspirational or relaxation CDs, meditation, and visualization.Occupational therapySome of the serious symptoms experienced by people with AIDS make it difficult for them to work or prevent them from working. Occupational therapy helps people gain employment after they have been unable to work for long periods of time. Occupational therapists tailor programs to restore function and devise ways to help people with AIDS function in the workplace The following laws help prevent people with HIV and AIDS from being discriminated at work: - The Americans with Disabilities Act prohibits discrimination in employment on the basis of a person's disability.
- The Family Medical Leave Act helps employees take leaves for serious health conditions.
Not all companies and employees are covered under these laws. Support groupsSupport groups provide coping suggestions, education, emotional support, social interaction, and help avoid feelings of isolation experienced by people with HIV and AIDS. Back to top Complementary and alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Whereas, complementary medicine is used with traditional medicine, alternative medicine is used in place of traditional medicine. People infected with HIV use complementary and alternative treatments to: - Maintain or regain their strength and energy
- Reduce any medication side effects
- Reduce stress
- Reduce their symptoms
- Relieve their pain
- Slow the progression of HIV
- Strengthen their immune system.
Although several alternative treatments show promise, at present, none is as effective as antiretroviral drugs in inhibiting HIV replication in the body. Research into complementary and alternative treatments for HIV and AIDS is currently being conducted. Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a doctor before trying them. Popular alternative treatmentsSome people with HIV use the following alternative treatments: - Chinese medicine
Chinese medicine uses herbal combinations, acupuncture, meditation, and massage techniques to improve the immune system. Several Chinese herbs have known antiretroviral drug interactions and should be avoided. - Herbs
Herbs include aloe, boxwood extract (has some serious side effects), cinnamon, curcumin, elderberry, schisandra, echinacea, ginseng, licorice. - Marijuana
Some people with AIDS use medical marijuana to stimulate their appetites or avoid nausea when taking their antiretroviral drugs. Although marijuana is illegal in the United States, a few states have laws that permit the use of marijuana for medical purposes. According to results of a trial conducted at the University of California, San Francisco, smoking marijuana significantly reduces nerve pain associated with HIV infection. Marinol (dronabinol) is an FDA-approved synthetic cannabinoid that may be prescribed for the treatment of weight loss in patients with AIDS. Some people feel it isn't as effective as natural marijuana. - Minerals
Minerals include iron, selenium, and zinc. - Mushrooms
Mushrooms include maitake and reishi. - Vitamins
Vitamins include vitamin A, B1, B2, B6, B12, C, E, and niacin. - Supplements
Supplements include beta-carotene, bovine colostrum, carnitine, coenzyme Q10, DHEA, glutamine, lipoic acid, MCTs (medium-chain triglycerides), methionine, NAC (n-acetyl cysteine), omega-3 and omega-6 fatty acids, propolis, proteolytic enzymes, spirulina, tea tree oil, and whey protein.
Natural herbs to avoidThe following herbs interact with antiretroviral drugs: garlic, milk thistle, and St. John's Wort. Back to top Several lifestyle changes can improve the quality of life for HIV-infected people and decrease the likelihood of disease. Avoid smoking, alcohol, and illegal drugsSmoking not only compromises a person's respiratory system, it's associated with heart disease and cancer. Alcohol is harmful to the liver. Illegal drugs can damage an already compromised immune system. Both alcohol and illegal drugs may interact with antiretroviral drugs.DietA well-balanced diet helps people keep healthy and strong, and maintain their energy and weight. People who suffer from a loss of appetite can eat frequent, small, high-calorie meals. A healthy diet prevents malnutrition, wasting, and weight loss. It also helps the body process antiretroviral drugs. - Fruits, vegetables, whole grains, and lean protein should be emphasized.
- Fat and sugar should be limited.
- Unpasteurized dairy products, undercooked meats, raw eggs and raw seafood should be avoided.
- Tap water may contain contaminants. Boiling or filtering drinking water helps prevent water-borne infections.
ExerciseRegular, moderate exercise can improve a person's appetite, circulation, endurance, energy, muscle mass, and strength. It also can reduce any feelings of stress and depression. Whereas regular moderate exercise has been shown to strengthen the immune system, intense exercise seems to decrease the immune system's ability to fight disease.HIV/AIDS SpecialistsBecause treatment for an HIV infection is a long-term commitment, it's important for people to feel confident in and comfortable with their healthcare providers. Not only should their physician and healthcare team have experience in treating HIV and AIDS, experienced subspecialists, such as dermatologists, gastroenterologists, and oncologists, are needed to treat any conditions that might develop. People infected with HIV should keep all appointments with healthcare workers, take all medications exactly as prescribed, and contact their healthcare providers whenever they experience new symptoms or medication side effects.ImmunizationsBecause people infected with HIV have weakened immune systems, it's important for them to get immunized for conditions such as the flu, pneumonia, and hepatitis. Live vaccines should be avoided.PetsPet ownership has been shown to improve the overall health and welfare of pet owners. People with HIV can keep their pets but need to be careful to avoid pet-borne infections, such as: - Cryptosporidiosis: a group of parasites that infect the human intestine.
- Mycobacterium avium complex: a bacterial infection that can cause abdominal pain.
- Toxoplasmosis: a protozoal infection of the brain that can be spread from cat litter or raw meat.
Protective measures people can use to avoid infections from animals include: - Always wash hands well with soap and water after contact with animals.
- Avoid handling sick pets, and stray or exotic animals or reptiles (reptiles are carriers of salmonella).
- Avoid pet saliva. If bitten or scratched, clean wound and seek medical advice
- Have another person clean cages and change litter boxes.
- Keep pets away from toilet bowls, garbage, and the stool of other animals.
- Only feed cooked meat to pets.
- Use flea treatments and dewormers (as needed) for pets.
Rest and relaxationRest and relaxation helps people infected with HIV maintain their strength and energy levels, and avoid fatigue.Soap and waterTo reduce the risk of infection, people with HIV should wash their hands thoroughly with soap and water before eating or preparing foods, and after using the restroom or spending time in public places. Alcohol-based hand sanitizers are useful when soap and water aren't available.
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