Saturday, May 28, 2022

How Do We Treat Hiv

The Role Of Primary Care Providers In New York State

How to treat HIV?

The goal of this guideline is to aid primary care providers and other clinicians in New York State in diagnosing and treating syphilis infection in adult patients with HIV. Primary care providers are often the first to see patients with STI symptoms. Nurses in New York State are authorized to execute non-patient specific orders and protocols for administering HIV testing and medically screening at-risk persons for syphilis, chlamydia and/or gonorrhea. As such, primary care providers and other clinicians assume a major role in the diagnosis and treatment of patients with HIV and STIs and in counseling patients to avoid or prevent high-risk behaviors that might lead to STIs.

The NYSDOH AI STI Committee has developed a set of measures designed to assess providers quality of STI care and treatment and identify areas for improvement, with the goal of reversing the rising rate of STI transmissions and recognizing sexual health as a primary care priority.

Managing Your Condition At Home

  • 1Create a daily routine for taking your medication. When you have HIV, its very important to take your medication every day in order to keep your infection under control. Skipping your medications can allow your infection to get worse, put you at risk of passing the virus on to others, and increase your risk of developing a drug-resistant strain of HIV.XTrustworthy SourceCenters for Disease Control and PreventionMain public health institute for the US, run by the Dept. of Health and Human ServicesGo to source Work on developing a routine to help you stay on top of your daily doses.XResearch source
  • Try to take your medications at the same time each day. To help you with this, you might set an alarm, use a medication reminder app, or ask a friend or family member to help remind you.
  • Let your doctor know if you have trouble sticking to your medication routine for any reason, such as difficulty remembering to take the pills, trouble swallowing your pills, or financial problems making it hard to afford your medication. They can give you advice about how to manage these issues.
  • Never stop taking your medications, even if you dont have any symptoms or tests show that your viral load is undetectable. Always talk to your doctor before making any changes to your medication routine.
  • If youre not sure which foods are healthiest for you, talk to your doctor or a dietitian.
  • Acetyl-L-carnitine. This supplement may help ease nerve pain associated with HIV.
  • Reporting: New York City

    Partner notification: The NYC DOHMH may contact the patient for epidemiological investigation or to offer assistance with partner notification.

    References

    AIDSinfo. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. 2017 Apr 12.

    Bala M, Mullick JB, Muralidhar S, et al. Gonorrhoea & its co-infection with other ulcerative, non-ulcerative sexually transmitted & HIV infection in a Regional STD Centre. Indian J Med Res 2011 133:346-9.

    CDC. 2016 Sexually Trasmitted Diseases Surveillance: STDs in Men Who Have Sex With Men. 2017 Aug 18.

    CDC. Discordant results from reverse sequence syphilis screeningfive laboratories, United States, 2006-2010. MMWR Morb Mortal Wkly Rep 2011 60:133-7.

    CDC. Self-Study STD Modules for CliniciansSyphilis: Patient Management/Treatment. 2013 Aug.

    Crum-Cianflone N, Weekes J, Bavaro M. Syphilitic hepatitis among HIV-infected patients. Int J STD AIDS 2009 20:278-84.

    Dobbin JM, Perkins JH. Otosyphilis and hearing loss: response to penicillin and steroid therapy. Laryngoscope 1983 93:1540-3.

    Dombrowski JC, Pedersen R, Marra CM, et al. Prevalence Estimates of Complicated Syphilis. Sex Transm Dis 2015 42:702-4.

    Feher J, Somogyi T, Timmer M, et al. Early syphilitic hepatitis. Lancet 1975 2:896-9.

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    When To Start Hiv Treatment

    Its now recommended that everyone diagnosed with HIV starts treatment straight away after being diagnosed.

    In the UK, national guidelines set out standards for HIV treatment. They currently recommend that anyone with HIV who is ready to commit to treatment should start it regardless of their CD4 count .

    What Else Do I Need To Know About Taking Hiv/aids Medicines

    Taking care of yourself when living with HIV

    It’s important to take your medicines every day, according to the instructions from your health care provider. If you miss doses or don’t follow a regular schedule, your treatment may not work, and the HIV virus may become resistant to the medicines.

    HIV medicines can cause side effects. Most of these side effects are manageable, but a few can be serious. Tell your health care provider about any side effects that you are having. Don’t stop taking your medicine without first talking to your provider. He or she may give you tips on how to deal with the side effects. In some cases, your provider may decide to change your medicines.

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    Acquired Hiv Drug Resistance

    Surveillance of acquired HIV drug resistance in populations receiving ART provides valuable data to inform the optimal selection and management of ART regimens. Among populations failing NNRTIs-based antiretroviral therapy, the levels of resistance to commonly used NNRTIs ranged from 50% to 97% and resistance to most commonly used NRTIs ranged from 21% to 91%.

    Whats The Treatment For Hiv

    Theres no cure for HIV, but there are treatments that help people with HIV live long, healthy lives. Antiretroviral therapy is a combination of medicines that slows down the effects of HIV in your body and can help you stay healthy for many years. It can also lower or even stop your chances of giving HIV to anyone else.

    ART lowers the amount of HIV in your body sometimes to the point where HIV wont show up on standard blood tests. If your HIV viral load is so low that certain tests cant see it, its called undetectable. When someone has an undetectable viral load, they cant spread HIV to others during sex.

    Its important to remember that even with an undetectable viral load, HIV is still present in your body. If you stop treatment your viral load can go up, making it possible to pass HIV to others you have sex with. Your doctor or nurse can help you find the treatment thats best for you to help keep your viral load low, so you can stay healthy.

    Paying attention to your lifestyle can help you stay healthy too. This means eating well, getting enough sleep, exercising, learning how to deal with stress, and avoiding alcohol, smoking, and drugs.

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    Are Hiv Medicines Used At Other Times To Prevent Hiv Transmission

    Yes, HIV medicines are also used for post-exposure prophylaxis and to prevent mother-to-child transmission of HIV.

    • Post-exposure prophylaxis PEP means taking HIV medicines within 72 hours after a possible exposure to HIV to prevent HIV infection. PEP should be used only in emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently. For more information, read the ClinicalInfo fact sheet on Post-Exposure Prophylaxis .
    • Prevention of mother-to-child transmission of HIV Pregnant women with HIV take HIV medicines for their own health and to prevent mother-to-child transmission of HIV. After birth, babies born to women with HIV receive HIV medicine to protect them from infection with any HIV that may have passed from mother to child during childbirth. For more information, read the ClinicalInfo fact sheet on Preventing Mother-to-Child Transmission of HIV.

    The Most Critical Time To Treat Is Right After Diagnosis

    How do we get more people on HIV treatment? And eliminate HIV infections among children?

    Findings from the START study have shown that early, if not immediate, treatment increases health and life expectancy, and prevents serious illness including cancer, renal and liver disease by more than 50% compared to those who delay starting treatment. Importantly, the study results confirm that there is no harm associated with immediate treatment.

    Further, in the early stages after contracting HIV your viral load is very high and that means youre at greater risk of transmitting HIV. HIV is actually much more likely to be transmitted by people who dont know theyve got it often, soon after they themselves have been infected.

    So, if youve been diagnosed with HIV, early treatment will keep you healthy and your partners safe. Win-win.

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    Nucleoside Reverse Transcriptase Inhibitors

    These drugs interrupt the virus from duplicating, which may slow the spread of HIV in the body. They include:

    • Abacavir
    • Zalcitabine
    • Zidovudine

    Combinations of NRTIs make it possible to take lower doses and maintain effectiveness. These drugs include Combivir , Trizivir , Epzicom and Truvada . We expect more combination drugs to be available in the future.

    How To Prevent Hiv Infection From Advancing To Aids

    “The best way to avoid AIDS is to start antiretroviral therapy as soon as possible, taking it diligently as it has been prescribed. These drugs will keep you healthy and make your viral level low, which can be detected. Sticking to the proper treatment can keep AIDS at bay for many years and decades. It practically eliminates the chances of passing HIV to your partners, says Dr Chowti.

    So, you must know that many HIV people live normal life spans.

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    Sti Rates On The Rise

    In Canada, the rate of new STIs is on the rise.4 According to the latest report published by the Public Health Agency of Canada, over the past decade chlamydia and gonorrhea rates have increased almost twofold, while syphilis rates have increased more than eightfold .

    The rate of new STI diagnoses is defined as the number of STIs diagnosed in the Canadian population over the course of a year. For example, if an STI had a rate of 150 in 2009, this means that 150 infections were diagnosed for every 100,000 people in the Canadian population that year.

    Research suggests that STIs are particularly prevalent among people living with HIV. A recent review of 37 studies found that, on average, 16.3% of people living with HIV were co-infected with another STI.5 Included in the review was a Canadian study, which enrolled people living with HIV from infectious disease clinics in Edmonton, Quebec City and Toronto of those participants, 54% were co-infected with genital herpes.6 Researchers also estimate that up to half of new syphilis cases in Canada occur in people living with HIV.7

    Stis: What Role Do They Play In Hiv Transmission

    HIV

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    Rates of sexually transmitted infections in Canada are on the rise. Research suggests that STIs can increase both a HIV-negative persons risk of becoming infected with HIV and an HIV-positive persons risk of transmitting HIV to someone else. This article explores how STIs may increase the risk of sexual HIV transmission, how STIs may be undermining our HIV prevention strategies, and what we can do about it.

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    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.

    Pretreatment Hiv Drug Resistance

    Drug resistance is also found in some people before they begin treatment with antiretroviral therapies. This resistance can either be transmitted at the time of HIV infection or acquired during previous treatments, for example in women given antiretroviral drugs to prevent mother-to-child transmission of HIV.

    Pretreatment resistance can affect more than 10% of people receiving these therapies for the first time and is found up to 3 times more often in people who had previous exposure to these drugs.

    The prevalence of pretreatment drug resistance is significantly higher in low- and middle-income countries than in wealthier nations.

    HIV drug resistance is also alarmingly high in children under 18 months of age that are newly diagnosed with HIV. Surveys conducted in 9 countries in sub-Saharan Africa between 2012 and 2018 found that over half of the infants newly diagnosed with HIV carry a virus that is resistant to the standard NNRTI class of drugs. Levels of pretreatment HIV drug resistance to another standard class of drugs called nucleoside reverse-transcriptase inhibitors, or NRTI also exceed 10% in some countries.

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    How Do We Implement Hiv Prevention On A Broad Scale

    Early detection and treatment prevents transmission of HIV and improves health outcomes for those infected. Research indicates that routine HIV screening in healthcare settings among populations with a prevalence rate as low as 1 percent is as cost effective as screening for other conditions such as breast cancer and high blood pressure. These findings suggest that HIV screening can lower healthcare costs by preventing highrisk practices and decreasing virus transmission.42

    More recently, scientists demonstrated43 that providing early HAART therapy to the HIV-infected partner of a heterosexual couple was 96 percent successful in preventing the spread of the virus to the uninfected partner. In fact, early initiation of HAART has been shown to be pivotal in reducing viral load and HIV incidence at the population level.44, 45 Capitalizing on these and other findings, researchers and clinicians have been testing and promoting the Seek, Test, Treat, and Retain approach to identify high-risk populations including substance abusers and those in the criminal justice system test them for HIV initiate HAART for those who test positive and provide the necessary support to help these individuals remain in treatment . These findings show great promise for preventing the spread of HIV and improving outcomes for those already infected, but studies are now needed to determine the most effective ways to scale up these interventions, especially in the most vulnerable populations.

    What Are The Types Of Hiv/aids Medicines

    Why cant we treat HIV / AIDS

    There are several different types of HIV/AIDS medicines. Some work by blocking or changing enzymes that HIV needs to make copies of itself. This prevents HIV from copying itself, which reduces the amount of HIV in the body. Several medicines do this:

    • Nucleoside reverse transcriptase inhibitors block an enzyme called reverse transcriptase
    • Non-nucleoside reverse transcriptase inhibitors bind to and later change reverse transcriptase
    • Integrase inhibitors block an enzyme called integrase
    • Protease inhibitors block an enzyme called protease

    Some HIV/AIDS medicines interfere with HIV’s ability to infect CD4 immune system cells:

    • Fusion inhibitors block HIV from entering the cells
    • CCR5 antagonists and post-attachment inhibitors block different molecules on the CD4 cells. To infect a cell, HIV has to bind to two types of molecules on the cell’s surface. Blocking either of these molecules prevents HIV from entering the cells.
    • Attachment inhibitors bind to a specific protein on the outer surface of HIV. This prevents HIV from entering the cell.

    In some cases, people take more than one medicine:

    • Pharmacokinetic enhancers boost the effectiveness of certain HIV/AIDS medicines. A pharmacokinetic enhancer slows the breakdown of the other medicine. This allows that medicine to stay in the body longer at a higher concentration.
    • Multidrug combinations include a combination of two or more different HIV/AIDS medicines

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    What Is An Undetectable Viral Load

    The aim of HIV treatment is to make you undetectable. This means that your viral load is so low that it cant be detected by the tests used to measure it.

    Different laboratories may have different cut off points when classifying an undetectable viral load. However, most clinics in the UK classify undetectable as being below 20 copies/ml.

    When you’re on effective treatment and have an undetectable viral load, you cannot pass on the virus and HIV is not able to damage your immune system.

    A large study called PARTNER looked at 888 gay and straight couples where one partner was HIV positive and one was HIV negative. Results found that where the HIV positive partner was on treatment and had an undetectable viral load, there were no cases of HIV transmission whether they had anal or vaginal sex without a condom.

    A follow-up study PARTNER 2 also reported zero transmissions after almost 800 gay couples had sex more than 77,000 without condoms.

    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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    Living With Hiv: What To Expect And Tips For Coping

    More than 1.2 million people in the United States are living with HIV. Its different for everybody, but with treatment, many can expect to live a long, productive life.

    The most important thing is to start antiretroviral treatment as soon as possible. By taking medications exactly as prescribed, people living with HIV can keep their viral load low and their immune system strong.

    Its also important to follow up with a healthcare provider regularly.

    Other ways people living with HIV can improve their health include:

    • Make their health their top priority. Steps to help people living with HIV feel their best include:
    • fueling their body with a well-balanced diet
    • exercising regularly
    • avoiding tobacco and other drugs
    • reporting any new symptoms to their healthcare provider right away
  • Focus on their mental health. They could consider seeing a licensed therapist who is experienced in treating people with HIV.
  • Use safer sex practices. Talk to their sexual partner. Get tested for other STIs. And use condoms and other barrier methods every time they have vaginal or anal sex.
  • Talk to their healthcare provider about PrEP and PEP. When used consistently by a person without HIV, pre-exposure prophylaxis and post-exposure prophylaxis can lower the chances of transmission. PrEP is most often recommended for people without HIV in relationships with people with HIV, but it can be used in other situations as well. Online sources for finding a PrEP provider include PrEP Locator and PleasePrEPMe.
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