Category Archives: hiv aids

HIV Treatment Drugs

Initial therapy for HIV

Guidelines for using antiviral therapy have been developed and are updated on a regular basis by an expert panel assembled by the DHHS, the IAS-USA panel, and others. The DHHS guidelines are available at http://www.aidsinfo.nih.gov. The most recent IAS-USA guidelines were published in the Journal of the American Medical Association (JAMA) in the summer of 2010.

Antiviral treatment options have primarily included combinations of two nucleoside analogue reverse transcriptase inhibitors (NRTI), often referred to as “nucs,” and one PI, typically with a low dose of Ritonavir, a PI used at low doses to increase the level of the principle PI being used, so called “boosting.”

Alternative, options include the use of two NRTIs with a nonnucleoside analogue reverse transcriptase inhibitor (NNRTI), the latter often called “non-nucs.” These NNRTI-containing combinations generally are easier to take than PI-containing combinations and tend to have different side effects. Recently, NRTIs were combined with the integrase inhibitor raltegravir with very good viral suppression and tolerability. This novel combination has now been approved by the Food and Drug Administration as another treatment option for those initiating therapy for the first time and is considered along with NNRTIs and PIs as one of the preferred options. Continue reading

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HIV cure and treatment guidelines

What are the key principles in managing HIV infection?

First of all, there is no evidence that people infected with HIV can be cured by the currently available therapies. In fact, individuals who are treated for years and are repeatedly found to have no virus in their blood experience a prompt rebound in the number of viral particles when therapy is discontinued. The decision to start therapy must balance the risk versus the benefits of treatment. The risks of therapy include the short- and long-term side effects of the drugs, as well as the possibility that the virus will become resistant to the therapy which can limit options for future treatment.

A major reason that resistance develops is the patient’s failure to correctly follow the prescribed treatment, for example, if the patient is not taking the medications at the correct time. If virus remains detectable on any given regimen, resistance eventually will develop. With certain drugs, resistance may develop in a matter of weeks, such as with lamivudine (Epivir, 3TC), emtricitabine (Emtriva, FTC), the drugs in the class of nonnucleoside analogue reverse transcriptase inhibitors (NNRTI) such as nevirapine (Viramune, NVP), delavirdine (Rescriptor, DLV), and efavirenz (Sustiva, EFV), and the integrase inhibitor raltegravir (Isentress, RAL). Thus, if these drugs are used as part of a combination of drugs that does not suppress the viral load to undetectable levels, resistance will develop rapidly and the treatment will lose its effectiveness. In contrast, HIV becomes resistant to certain other drugs, such as zidovudine (Retrovir, AZT), stavudine (Zerit, D4T), and protease inhibitors (PIs), over months. In fact, for some Protease Inhibitors whose effects are enhanced by giving them in combination with the ritonavir (Norvir, RTV) to delay their clearance by the body, resistance appears to be markedly delayed. These drugs are discussed in more detail in subsequent sections, but it is important to note that when resistance develops to one drug, it often results in resistance to other related drugs of the same class, it is called cross-resistance. Nevertheless, HIV-infected individuals must realize that antiviral therapy can be and typically is very effective as long as drug resistance has not developed even in patients with very low CD4 count and high viral load. Continue reading

Students hold oil lamps beside a symbol of AIDS in Chennai

HIV Testing

How to diagnose HIV/AIDS?

HIV is most commonly diagnosed by testing blood or saliva for the presence of antibodies to the virus. These types of HIV tests aren’t accurate immediately after infection because body takes time to develop these antibodies — usually up to 12 weeks. In rare cases, it can take up to six months for an HIV antibody test to become positive.

A newer type of test checks for HIV antigen, a protein produced by the virus immediately after infection. This test can confirm a diagnosis within days of infection. An earlier  diagnosis help people to take extra precautions to prevent transmission of the virus to others.

Tests to start treatment:

If you receive a diagnosis of HIV/AIDS, several types of tests can help your doctor determine what stage of the disease you have. These tests include:

  • CD4 count. CD4 cells are a type of white blood cell that’s specifically targeted and destroyed by HIV. A healthy person’s CD4 count can vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4 count becomes less than 200.
  • Viral load. This test measures the amount of virus in your blood. Studies have shown that people with higher viral loads generally have poor prognosis than do those with a lower viral load.
  • Drug resistance. This type of test determines if your strain of HIV is resistant to any anti-HIV medications. Continue reading
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HIV AIDS Symptoms

What are symptoms and signs of HIV infection and AIDS?

The time from HIV infection to the development of full blown AIDS varies. Sometimes, individuals develop complications of HIV that define AIDS within one year, while others remain completely asymptomatic after as many as 20 years from the time of infection. However, in the absence of antiretroviral therapy the time for progression from initial infection to AIDS is approximately 8 to 10 years. The reason why people experience clinical progression of HIV at different rates remains an area of active research.

Within weeks of infection, many people will develop the varied symptoms of primary or acute infection which typically have been described as “influenza” like illness but can range from minimal fever, body aches, and pains to very severe symptoms. The most common initial symptoms of primary HIV infection are fever, aching muscles and joints ,sore throat, and swollen glands (lymph nodes) in the neck.

It is not known why only some HIV-infected people develop these symptoms. It also is unknown whether or not having the symptoms is related to the future course of AIDS disease. Nevertheless, infected people will become symptom-free after this phase of primary infection. During the first weeks of infection when a patient may have symptoms of primary HIV infection, antibody testing may still be negative, this is called window period. If there is suspicion of early infection based upon the types of symptoms present and a potential recent exposure, then a test is performed that specifically looks for the virus circulating in the blood, which is called a viral load test or the use of an assay that identifies HIV p24 antigen, for example, the new fourth-generation antibody/antigen combination test. Identifying and diagnosing individuals with primary infection at an early stage is important to assure early access into care and to counsel them regarding the risk of transmitting to others. The latter is particularly important since patients with primary HIV infection have very high levels of virus throughout their body and are likely to be highly infectious. Once the patient enters the asymptomatic phase, infected individuals will know whether or not they are infected if a test for HIV antibodies is done.

Shortly after primary infection, most individuals enter a period of many years where they have no symptoms at all. During this time, CD4 cells may gradually decline, and with this decline in the immune system, patients may develop the mild symptoms of HIV such as vaginal or oral candidiasis thrush (a fungal infection), fungal infections of the nails, a white brush-like border on the sides of tongue called hairy leukoplakia, chronic rashes, diarrhea, fatigue, and weight loss. With a further decline in function of the immune system, patients are at increasing risk of developing more severe complications of HIV, including many more serious infections (opportunistic infections), malignancies, severe weight loss, and decline in mental function. From a practical perspective, most physicians think about patients with HIV diseases as having no symptoms, mild symptoms, or being severely symptomatic. In addition, many would characterize a patient’s level of immunosuppression by the degree and type of symptoms they have as well as the CD4 cell count. The Centers for Disease Control and Prevention have defined the presence of a long list of specific diseases or the presence of less than 200 CD4 cells per mm3 as meeting a somewhat arbitrary definition of AIDS. With effective antiretroviral therapy many of the signs and symptoms of HIV as well as immunosuppression can be completely reversed, restoring even the most symptomatic patients to a state of excellent health.

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HIV AIDS

What is HIV AIDS?

HIV stands for Human Immuno-deficiency Virus. It is responsible for causing AIDS (Acquired Immuno Deficiency Syndrome) in humans. HIV belongs to the group of retrovirus. As this virus enters into the body, it starts destroying the cells of the immune system. In the meantime, the immune system tries to make new cells but gradually HIV destroys the capability of the body to fight infection and new cells formation. Without treatment, the immune system will become too weak to fight off illness and a person with HIV may develop rare infections or cancers. When these are particularly serious, the person is said to have AIDS (Acquired Immune Deficiency Syndrome).

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