Treatment and living with HIV/AIDS
An HIV positive individual will need to come to terms with continuously being subjected to various medical checks and testing procedures for the remainder of their lives. Medications will be prescribed and taken on a continuous basis too.
There is no cure and neither is there an effective vaccine for HIV/AIDS as yet. It is thus imperative that medical treatment is adhered to for the best quality of life possible post diagnosis.
Doctors will recommend a variety of medications that can be used in combination as a way to best control the effects of the virus in the body. Anti-HIV medications are classified in different tiers. Each class (or tier) works to block the virus in different ways. A doctor will usually prescribe at least 3 medications from two different classes to best accomplish this. Combination treatment has shown to be most effective for avoiding the development of different strains of HIV in the body that become immune or resistant to medications.
Anti-HIV medication (ARTs) classes include:
- NNRTIs (non-nucleoside reverse transcriptase inhibitors): These medications disable the protein (antibody) the virus makes use of to copy itself in the body.
- NRTIs (nucleoside or nucleoside reverse transcriptase inhibitors): These medications are designed as faulty versions of the antibodies (protein building blocks) that the virus uses to make copies of itself in the body. The faulty versions thus prevent the ability to do so.
- PIs (protease inhibitors): Another protein the virus feeds on to produce copies of itself is protease. These medications disable the protein to prevent this.
- Fusion or entry inhibitors: These medications work to block the ability of the virus to target (enter) the body’s CD4 cells.
- Integrase inhibitors: HIV makes use of another protein called integrase to insert its genetic material in the body’s CD4 cells. These medications work to block this action and effectively disable the protein.
Treatment with antiretroviral medications (ART) will require multiple pill-taking in specific dosages and at certain times of the day, every day for the remainder of a person’s life. The sooner medications are used, the better for the individual with HIV.
Currently, a doctor has more than two dozen ART medication options to choose from in order to treat an infection. Each medication works differently to control the virus in the body and will be prescribed as appropriate on an individual basis. A doctor will take into account how well a person’s immune system is functioning, and all related medical health issues that are being experienced too. As and when new symptoms arise, other medication to treat these may be prescribed from time to time.
The body’s response to treatment may fluctuate. Monitoring from medical professionals will serve an infected person well and ensure their best quality of life. Doctors will work to achieve an undetectable viral load with treatment. This effectively will not mean that an infection ‘has been cured’, but rather that the load is low enough not to cause too many or any associated complications.
All treatment programs will need to be tailored to the individual. An HIV positive person must disclose their entire medical history to ensure that their doctor prescribes the best course of action that doesn’t compromise the effectiveness of their treatment. A doctor will wish to know about all previous health concerns and diagnosed problems, as well as make note of any medications and supplements (prescribed or over-the-counter) an HIV positive person is taking. If any recreational or illicit drugs are being used, this needs to be disclosed as well.
Medical professionals around the world are constantly working to develop better treatment management options to ensure longer and improved quality of life for all HIV positive individuals. Treatment options today are far better than they were just a handful of decades ago.
It is critical that an HIV positive individual not stop taking their prescribed ART medications. Any interruption to treatment allows the virus opportunity to strengthen and do further damage to the body. Ultimately, a person’s quality of life will decline if medication is not taken properly.
Treatment can be a costly exercise. A person with HIV will need to look into what their medical health insurance provider will cover and what may not be claimed for. Those without medical insurance should look into various options that may be available in the country they reside in for assistance.
What types of complications or side-effects are common?
As much as there are valuable benefits to medical treatment, the taking of medications is not without discomfort. Unfortunately, treatment can be troublesome for an HIV positive individual.
Common side-effects associated with the taking of ARTs include:
- Nausea and vomiting
- Rhabdomyolysis (the breakdown of muscle tissue)
- Bone weakening or bone loss
- High blood sugar levels
- Abnormal cholesterol levels
- Skin rashes
- Sleeping problems
- Tingling sensations or numbness
Side-effects may not be constant and can be experienced in varying degrees. Side-effects may be worse at the start of treatment and subside as the body settles (adjusts). If particularly bothersome, a doctor can recommend methods (such as taking medications on an empty stomach) or other medications that can help to alleviate discomfort.
An HIV positive person may have side-effects that linger and become long-term. These can include:
- Fat re-distribution (lipodystrophy): The body can experience changes in the way it makes, uses and stores fat. A person may lose fat in certain areas, such as the limbs or face, but gain in the abdominal area. Medications can help to prevent worsening of this condition.
- High blood sugar, cholesterol or triglyceride levels: These can be treated with medications, and changes to diet and exercise activity.
- Bone density loss: Fractures and breaks are common as a person ages. Walking and weight-lifting may be recommended to build strength. Calcium and vitamin D supplements may also be recommended.
- Lactic acidosis: It is rare, but it can happen that a build-up of lactic acid (a cellular waste product) develops, causing a range of ailments such as liver failure and muscles ages. Medications may be adjusted to help manage this.
Medical attention is required right away if a person experiences abdominal pain, high fever, a stiff neck or trouble breathing.
With a compromised immune system, an HIV positive person is at high-risk for numerous other infections and ailments or diseases, such as cancer.
The list of common complications and opportunistic infections includes:
- Tuberculosis (TB)
- Candidiasis (an HIV-related yeast infection causing inflammation and a thick white coating on the mucous membranes of the oesophagus, mouth, tongue and vagina)
- Cytomegalovirus (common variation of the herpes virus causing damage to the eyes, digestive tract and organs such as the lungs)
- Toxoplasmosis (a potentially serious infection affecting the brain caused by the Toxoplasma gondii parasite commonly spread by cats through contact with their stool or faeces)
- Cryptococcal meningitis (central nervous system infection caused by soil fungi)
- Cryptosporidiosis (an infection caused by an intestinal parasite found in animals resulting in severe diarrhoea)
- Kaposi’s sarcoma (a cancerous tumour of the blood vessel walls resulting in pink, red, purple, dark brown or black skin lesions which can also occur in the mouth, or in the digestive tract and lungs)
- Lymphomas (cancer that develops in the body’s white blood cells and affecting the lymph nodes in the neck, armpits and groin area)
- Kidney disease (HIV-associated nephropathy / HIVAN causing inflammation in the kidney’s tiny filters which normally remove excess waste and fluid from the bloodstream and expelled through urine)
- Wasting syndrome (a loss of approximately 10% of body weight due to chronic weakness, diarrhoea and fever)
- Neurological issues (confusion, depression, forgetfulness, anxiety, difficulties with walking, behavioural changes, diminished mental functioning and AIDS dementia)
- Histoplasmosis (lung infection)
- PCP (known as pneumocystis carinii pneumonia or pneumocystis jiroveci pneumonia)
- Recurrent pneumonia
- Chronic oral herpes (herpes simplex virus type 1 / HSV-1) ulcers and blisters
- Mycobacterium avium complex (a bacterial infection)
- Isosporiasis (disease of the intestine)
- Recurrent salmonella septicaemia
- Cervical cancer
- PML (progressive multifocal leukoencephalopathy – a disease of the brain)