Preventing HIV : What Every Woman Can Do ! |
Treating HIV (human immunodeficiency virus, the virus that causes AIDS) is one of most rapidly evolving fields in medicine. New therapies, different combinations of drugs and improved methods for monitoring infection make treatment increasingly complex. There are three important facts about treatment for HIV: * It is available and may be valuable for HIV-infected persons who are asymptomatic (without symptoms). * It can delay progression to AIDS. * HIV therapy and drug development change all the time, so it is important to keep up with the latest findings. In 1996, with the advent of a class of drugs called protease inhibitors, a new model was introduced for treating HIV infection. Prior to these powerful drugs, treatment often was delayed until an infected person developed symptoms, often years after exposure to the virus. First, researchers now know that drug therapy initiated soon after infection can dampen the initial viral surge that spreads through the body. By keeping the virus in check, the drugs can delay the gradual weakening of the immune system. Second, effective treatment is likely to reduce the chances of an infected person transmitting the virus: drugs not only lower the amount of virus in the blood but in bodily fluids as well. Finally, people on early treatment with powerful drug combinations can delay symptoms of infection longer (possibly indefinitely) than those not receiving treatment. You have probably heard how these potent drugs used in different combinations have allowed patients once disabled by AIDS to return to work and remain free from serious symptoms. The long-term impact of these drugs remains unknown. Once the drugs are stopped, the virus often returns in full force. Moreover, there are HIV strains developing that can resist the drugs. Still, while this means taking many pills a day, with potentially significant side effects, HIV has become a condition that can be managed, much like diabetes or high blood pressure. A treatment management tool introduced in 1996, the viral load test, can accurately monitor and predict how well your body is responding to treatment. The test measures the amount of HIV in your blood in medical terms, "plasma HIV RNA" and is quantified as "copies per milliliter." A high viral load, such as 100,000 or 1 million copies per ml, indicates a person is rapidly progressing to AIDS. A viral load of 1,000 or lower means the immune system is doing a good job of keeping the virus in check and infection is not progressing to AIDS. Viral load testing is an invaluable treatment guide today in the same way a CD4+ count (testing for white blood cells called T-lymphocytes) was in the first decade of the epidemic. The goal of treatment is to reduce the amount of virus in the bloodstream to so low a level it cannot be detected by a sensitive viral load test. Indeed, having "undetectable" virus has become the benchmark for measuring a successful therapy regimen. Initiated prior to treatment or whenever treatment is changed, viral load testing provides timely information for deciding not only when you should start treatment but when to switch to different drugs if treatment proves ineffective or resistance is developing. The NucliSens HIV-1 QT viral load test, for example, was approved by the U.S. Food and Drug Administration (FDA) in 2001 for both pediatric and adult patients. When should antiretroviral treatment be initiated for an HIV-infected patient? According to new treatment guidelines issued by the U.S Department of Health and Human Services, a decision regarding initiation or changes in antiretroviral therapy should be guided by monitoring the laboratory parameters of plasma HIV RNA (viral load) and CD4+ T cell count, as well as the clinical condition of the patient. In general, treatment should be offered to individuals with fewer than 350 CD4+ T cells/cu. mm or plasma HIV RNA levels exceeding 55,000 copies/ml. Recently, the FDA approved a gene sequencing test to warn health care professionals and patients of potential drug resistance problems before therapy actually begins. Called the "Trugene HIV-1 Genotyping Kit and OpenGene DNA Sequencing System," the test is for routine use in health care providers' offices and is the first such type of drug resistance test to receive clearance from the FDA. Treatment options have increased dramatically now that 18 drugs are approved for HIV therapy. The drugs fall into three major classes: nucleoside reverse transcriptase inhibitors (NRTIs), which target an enzyme HIV uses known as reverse transcriptase; non-nucleoside reverse transcriptase inhibitors (NNRTIs), which also target the enzyme but work in a different way; and protease inhibitors, which prevent HIV from making copies after it has entered a cell. Nucleoside reverse transcriptase inhibitors include: * abacavir (Ziagen) * AZT (zidovudine, azidothymidine, Retrovir) * 3TC (lamivudine, Epivir, Zeffix) * Combivir (a combination of zidovudine and lamivudine) * ddC (zalcitabine, dideoxycytidine, HIVID) * d4T (stavudine, Zerit) * ddI (didanosine, Videx, Videx EC) * Viread (Tenofovir) * Trizivir (a combination of AZT/3TC and abacavir) Non-nucleoside reverse transcriptase inhibitors include: * nevirapine (Viramune) * efavirenz (Sustiva, Stocrin) * delavirdine (Rescriptor) Protease inhibitors include: * indinavir (Crixivan) * ritonavir (Norvir) * nelfinavir (Viracept) * saquinavir (Invirase and Fortovase) * amprenavir (Agenerase) * lopinavir/ritonavir (Kaletra; ABT-378) While effectiveness in attacking the virus is the main consideration for choosing a particular drug or drug combination, you should also be aware of the potential for toxic or allergic side effects, known as adverse drug reactions. For example, protease inhibitors can redistribute fat cells in some patients. This condition, called lipodystrophy, causes the formation of paunches or humps with fat wasting in the face, arms or legs. More common side effects from antiviral drugs are headache, fever, rash and nausea. Yet another consideration is the risk of adverse drug interactions. This is one more reason you should receive treatment from a provider experienced in HIV care. The third benefit from HIV treatment is its potential to prevent the serious opportunistic infections that make AIDS a debilitating condition. Prior to protease inhibitors, many AIDS patients were given antibiotics to ward off PCP (Pneumocystis Carinii Pneumonia) and MAC (Mycobacterium Avium Complex). Combination therapy has become so effective in strengthening the immune system that many patients can be taken off these lifelong regimens without a high risk of recurrent infection. From Women's Health Resource Center |
HIV: Saving Your Life The Treatments That Can Help |
Preventing HIV : What Every Woman Can Do ! |
