Antiretroviral Treatment And The Hiv Lifecycle
Antiretroviral treatment for HIV combines several different types of drugs, each of which targets a different stage in the HIV lifecycle. This means that the replication of HIV is stopped on multiple fronts, making it very effective.
If taken correctly, it keeps the immune system healthy, prevents the symptoms and illnesses associated with AIDS from developing, and means that people can enjoy long and healthy lives.
If someone doesnt take their treatment correctly or consistently , the level of HIV in their blood may increase and the drugs may no longer work. This is known as developing drug resistance.
Whats The Difference Between Pep & Prep Hiv Prevention Pill
Post-exposure prophylaxis is a time-sensitive form of HIV prevention where HIV-negative individuals take medications after coming into contact with HIV to dramatically reduce their risk of becoming infected. Unlike PrEP, PEP is only a month-long course of drugs, but it must be started within 72 hours after being exposed to HIV. While PEP is used as a short-term HIV prevention strategy after one suspects they may contracted the virus, PrEP is a long-term, ongoing form of treatment that gives individuals greater peace of mind. For more information read my blog post or listen to my podcast episode about PrEP vs. PEP.
How Hiv Drugs Work 101
_Adapted from the 1998 edition of _ HIV 101 Positively Aware
There are three categories of HIV antiviral drugs that have FDA approval. Nucleosides and non-nucleosides work to stop HIV from infecting cells and protease inhibitors stop infected cells, from reproducing the virus. In addition, new classes of drugs to treat HIV/AIDS are on the horizon. Fusion inhibitors, nucleotide inhibitors and immune modulators may be available in the near future.
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How Should I Take My Antiretroviral Treatment
When and how you take your ART will vary depending on the specific antiretroviral drugs you take. Most antiretroviral drugs are taken once a day, with or without food. However, some drugs are taken twice a day. If this might be something you find difficult, talk to your doctor about your options.
Once you start ART its very important that you take it properly and dont miss or skip doses, as this can lead to something called HIV drug resistance, and may mean that your drugs dont work as well for you in the future. If youre finding it hard to take your treatment at the right times and in the right way, speak to your healthcare worker. They can offer you support and give you advice on how to make taking your treatment easier.
What Is Hiv Treatment
HIV treatment involves taking medicines that slow the progression of the virus in your body. HIV is a type of virus called a retrovirus, and the combination of drugs used to treat it is called antiretroviral therapy . ART is recommended for all people living with HIV, regardless of how long theyve had the virus or how healthy they are. ART must be taken every day, exactly as your health care provider prescribes.
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Data For Clinical Benefit Of Antiretroviral Therapy
The Adult and Adolescent ARV Guidelines recommendation to initiate antiretroviral therapy in all persons living with HIV to reduce morbidity and mortality is based on multiple cohort studies and clinical trials, as outlined below, that have shown a clear benefit of starting antiretroviral therapy earlier in the course of HIV disease progression.
What To Expect During Treatment
People using antiretroviral therapy take these medications for the rest of their lives. It is estimated that the lifespan of a person with HIV today is similar to that of a person who is not infected with HIV, as long as they consistently take their antiretroviral medications.
HIV infection and antiretroviral therapy may increase cardiovascular risk as a result of increased inflammation which may affect the amount of cholesterol in the blood. People on antiretroviral therapy can sometimes experience side effects, such as nausea, vomiting, diarrhea, or skin rashes. Doctors monitor you for these side effects, and can offer a different medication regimen if needed.
You doctor conducts blood testing every three months to measure your CD4 levels and viral load, which are used to determine the amount of HIV in the blood. The goal of treatment is to return CD4 levels to normal, improving the immune systems ability to fight infection, and to suppress the amount of virus in the blood to the point where it cant be detected by a lab test.
NYU Langone doctors also treat any problems related to HIV infection, such as anemia, which is caused by low levels of red blood cells, and dangerously low white blood cell levels, which may lead to infection or cancer.
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What If I Have Another Illness Or A Co
In these situations your doctor may need to tailor your antiretroviral treatment or treat your other condition before starting your HIV treatment. This will be explained to you by the clinicians looking after you.
What Hiv Medicines Are Included In An Hiv Regimen
There are many HIV medicines available for HIV regimens. The HIV medicines are grouped into seven drug classes according to how they fight HIV.
The choice of an HIV regimen depends on a person’s individual needs. When choosing an HIV regimen, people with HIV and their health care providers consider many factors, including possible side effects of HIV medicines and potential drug interactions.
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How Can I Get An Erection Without Pills
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Blocking Replication Of The Virus
Once HIV has entered the cell, the virus continues the process to reproduce itself. Early in this phase, viral RNA is copied into DNA using an enzyme called reverse transcriptase.
This viral DNA copy would then be integrated into the host cell DNA. Various ARV drugs are known to block reverse transcription, interrupting that process.
Reverse transcriptase inhibitors come in two classes: non-nucleoside reverse transcriptase inhibitors and NRTIs .
- NNRTIs work by binding to the HIV enzyme called reverse transcriptase, which is essential to the viral replication process, and therefore blocking HIV from making copies of itself. Dapivirine is an example of an NNRTI.
- NRTIs work by mimicking nucleotides that are the building blocks of viral DNA. These compounds act like a bad link in a chain. Once they are incorporated into the viral DNA, the next link cannot be added, so the viral DNA stops growing, and the reverse transcription process is blocked. Tenofovir is an example of an NRTI.
Also being researched are two additional ARV types for use as microbicides.
- Integrase inhibitors prevent the virus from permanently inserting its genetic material into human chromosomes another way to block viral reproduction.
- Protease inhibitors, such as darunavir, prevent HIV from constructing the protein components it needs to assemble new viruses.
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Who Should Consider Taking Pep
If you are HIV-negative and you think you may have been recently exposed to HIV, contact your health care provider immediately or go to an emergency room right away.
You may be prescribed PEP if you are HIV negative or dont know your HIV status, and in the last 72 hours you
- Think you may have been exposed to HIV during sex,
- Shared needles or drug preparation equipment, OR
- Were sexually assaulted
Your health care provider or emergency room doctor will help to decide whether PEP is right for you.
PEP may also be given to a health care worker after a possible exposure to HIV at work, for example, from a needlestick injury.
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What Are Drug Interactions
Your HIV medications can be affected by other medicines, including other prescription drugs you are taking and drugs you buy over the counter at a pharmacy. Even herbal therapies, nutritional supplements, and some things found in common foods can affect your HIV medicines.
When one drug affects how another drug behaves, this is called a drug-drug interaction. For example, some drugs become less effective or cause side effects when they are taken with certain other drugs.
When something in food affects how a drug behaves, it is called a drug-food interaction. For example, grapefruit juice, taken at the same time as certain drugs, can boost the amount of these drugs in your bloodstream to an undesirable level. Everyone taking HIV drugs needs to be very careful about these interactions. Luckily, many of these interactions are well known to your provider and can be managed.
Your provider can give you a list of drugs and foods to avoid, depending on what treatment you are taking. Ask for this information for each drug that you are taking.
Also, be sure that you tell your provider about every single medication, drug, supplement, and herb you are taking–whether you got them by prescription or not.
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Treatment Helps Prevent Transmission To Others
- If you have an undetectable viral load, you have effectively no risk of transmitting HIV to an HIV-negative partner through sex.
- Having an undetectable viral load may also help prevent transmission from injection drug use. We dont have data about whether having an undetectable viral load prevents transmission through sharing needles, syringes, or other injection equipment . It very likely reduces the risk, but we dont know by how much.
- Having an undetectable viral load also helps prevent transmission from mother to baby. If a mother with HIV takes HIV medicine as prescribed throughout pregnancy, labor, and delivery and gives HIV medicine to her baby for 4 to 6 weeks after birth, the risk of transmitting HIV to her baby can be 1% or less.
- Having an undetectable viral load reduces the risk of transmitting HIV to the baby through breastfeeding, but doesnt eliminate the risk. The current recommendation in the United States is that mothers with HIV should not breastfeed their babies.
Could Prep Work For Me
It doesnt matter what your gender identity and sexual orientation are. Its a good option for someone in any of these situations:
- In an ongoing relationship with an HIV-positive partner
- Has sex with multiple partners and doesnt always use condoms
- Injects drugs or shares needles
Research is still being done on the effects of taking PrEP when youre transgender and having hormone therapy. No bad reactions have been reported so far.
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Talk To A Healthcare Provider
Theres no cure for HIV yet, but prescription medications can help slow the progression of the virus. Drugs can also improve HIV symptoms and make living with the condition more comfortable.
This medication list is a brief overview of the types of drugs that are available to treat HIV. Talk to a healthcare provider about all of these options. They can help you determine your best treatment plan.
How Do You Know If You Need Pep
PEP may be right for you if you are HIV-negative or dont know your HIV status, and you think you may have been exposed to HIV in the last 72 hours:
- During sex
- Through shared needles, syringes, or other equipment used to inject drugs, or
- Through sexual assault
Contact your health care provider immediately or go to an emergency room or urgent care clinic right away.
Your health care provider or emergency room doctor will evaluate you, help you decide whether PEP is right for you, and work with you to determine which medicines to take for PEP.
In addition, if you are a health care worker, you may be prescribed PEP after a possible exposure to HIV at work, such as from a needlestick injury.
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Should You Ever Switch The Drugs You’re Taking
You should never change the drug plan you’re on without talking with your provider. This is a very important decision and one that must be made with your provider.
There are a few reasons that your provider may suggest you change your medicines. There may be a fixed-dose combination pill that could simplify your therapy. Or your treatment may not be working well enough and you may need different medicines. Or you may have side effects that are bothering you, or lab tests that show signs of ill effects from the HIV drugs .
Before changing medicines, you and your provider should talk about:
- All the HIV drugs you have taken before and the ones you haven’t taken
- Any drug resistance your HIV virus may have
- Possible side effects of the new medicines
- How well you will be able to follow the new drug treatment plan
Always be sure to talk with your provider about any changes in your drug treatment.
How Does Antiretroviral Therapy Work
Antiretroviral therapy medication prevents the human immunodeficiency virus from multiplying, which reduces the viral load in the body. Having less HIV in the body allows the immune system to recover and produce more infection-fighting CD4 cells. Because the amount of HIV in the body is reduced, this also helps reduce the risk of HIV transmission.
There are several steps in the life cycle of HIV that form the basis for antiretroviral therapy.
HIV circulates in the bloodstream and binds to receptors on the surface of the CD4 immune cells, which leads to membrane fusion and internalization of the viral genetic material and enzymes necessary for replication of the virus.
Entry inhibitors include:
- Fusion inhibitor enfuvirtide
HIV uses reverse transcriptase to convert its genetic material into DNA, which results viral DNA migrating into the nucleus of the cell.
Nucleoside/nucleotide reverse transcriptase inhibitors include:
- Tenofovir disoproxil fumarate and tenofovir alafenamide
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Access Prep Through The Australian Healthcare System
If you are an Australian resident with a current Medicare card you can access PrEP through the PBS at a subsidised cost. This means any doctor or general practitioner can write a script for PrEP which you can take to any pharmacy for dispensing or visit the PrEP Access Now website for other cost-effective options. Keep in mind you may have to pay for your doctors visit if its not a bulk billing service.
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Can You Get Help Paying For Pep
- If youre prescribed PEP after a sexual assaultYou may qualify for partial or total reimbursement for medicines and clinical care costs through the Office for Victims of Crime, funded by the U.S. Department of Justice .
- If youre prescribed PEP for another reason and you cannot get insurance coverage Your health care provider can apply for free PEP medicines through the medication assistance programs run by the manufacturers. These requests can be handled urgently in many cases to avoid a delay in getting medicine.
- If youre a health care worker who was exposed to HIV on the jobYour workplace health insurance or workers compensation will usually pay for PEP.
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What Is Antiretroviral Therapy
Antiretroviral therapy refers to combination drug therapy used to treat human immunodeficiency virus . Antiretroviral drug therapy frequently combines three or more drugs from more than one class to help prevent drug resistance.
Antiretroviral therapy does not cure HIV, but it helps patients live longer and also reduces the risk of transmitting the virus to others. People who are diagnosed with HIV should start taking HIV medications right away.
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