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Treatment for HIV

Drug treatments for HIV offer some 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 then, due to reductions in AIDS 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, Unfortunately, the drugs do not work as well for everyone, and they also have quite a lot of side effects. Deciding whether or not to take treatment is an individual decision which you should consider carefully and discuss all of the options with your doctor.

Types of Treatment

Drug treatment is usually called 'HAART' which stands for 'Highly Active Anti Retroviral Therapy'. HIV is a type of virus called retrovirus, so antiretroviral drugs are drugs which work against retroviruses.

There are three main groups of drugs:

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

Usually, three different drugs from at least two of these group are taken together, two or four times a day.

How treatment works

The drugs control the virus by stopping it from making copies of itself inside the cells of the body. The virus gets into a body cell and starts to make more copies of itself, which then spread out of that cell and into another. Drug treatments interfere with the chemicals that the virus uses to make these copies. One of these chemicals is called ‘reverse transcriptase’, and the other is called ‘protease’. So reverse transcriptase inhibitors stop reverse transcriptase from working, and protease inhibitors stop protease from working.

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. A lot of research is being done in this area, to see if people with HIV will be able to take short breaks from treatment without harmful effects. This may be a possibility for the future, but at the moment, it is not recommended that anyone interrupt drug treatment without medical advice.

The drugs cannot eliminate all of the virus in the body, but they can control it. People on treatment will still have HIV in their body, even when blood tests show the virus is 'undetectable'. Although an 'undetectable' result is good news, it means that as far as that test can tell, it can’t find virus in the blood. A more sensitive test could possibly still find some virus, and also the virus may still be found in the semen or in the lymph glands.

Treatment does not stop someone with HIV from being able to pass on the virus through unprotected sex or sharing needles.

Side Effects

Some of the most common side effects are:

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

Side effects are a big problem with treatment, although it would be unusual for someone to get all of them at the same time. Sometimes the side effect can be controlled with other medication, or is not too severe and can be tolerated. Sometimes treatment regimes need to be altered because of side effects. There is some good advice about side effects available on the Internet from Project Inform, access through www.thebody.com

You could also talk to your doctor or a Treatment Officer at your State HIV/AIDS office.

Testing

The two blood tests which are used to see how well the treatment is working are the viral load test and the CD4 count.

The viral load test measures how much virus can be found in the blood. Usually, people who are just starting treatment will have high levels of the virus. One of the aims of the treatment is to reduce this level until it is ‘undetectable’, which means the test cannot fin any virus. It doesn’t actually mean that all of the virus is gone, but it does mean that it is under control.

The CD4 count measures how many of a certain type of white blood cell can be found in the blood. This is also sometimes called the ‘t-cell count’. The CD4 count is one way of seeing how well the immune system is working. The higher the CD4 count, the healthier the immune system is. This means that the risk of other infections, such as pneumonia, is much less. One of the aims of treatment is to see the CD4 count go up, showing that the immune system is getting stronger.

Some people with HIV use other types of therapy, either alone or with their treatments. (see Complementary Therapies information sheet)

For More Advice:

  • A doctor who specialises in HIV
  • Education and Resource Centre – Tel. (03) 9076 6993
  • Melbourne Sexual Health Centre Treatments Officer (Green Room) – Tel. (03) 9341 6214
  • Straight Arrows – Tel. (03) 9863 9414
  • Victorian AIDS Council (03) 9865 6700
  • Victorian HIV/AIDS Service, The Alfred, Infectious Diseases Outpatient Clinic – Tel: (03) 9076 6081

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