Ecdc Comment: Prevention Benefits Of Viral Suppression
The encouraging PARTNER2 study results give further impulse on the way towards the global target of ending AIDS by 2030. They can particularly address and help reduce HIV-related stigma, both among HIV-positive people as well as the public, by reinforcing the message: people living with HIV who are on effective ART do not pass on the virus.
In fact, achieving and maintaining an undetectable viral load serves as a very effective prevention method to help interrupt existing transmission chains. This applies for gay men as well as heterosexual couples.
However, reaching and maintaining an undetectable viral load is just one step in the socalled HIV continuum of care. Effective HIV treatment depends on being diagnosed and starting treatment early and adhering to it closely at a time when an estimated 11-17% of people living with HIV in the European Union and European Economic area are not even aware of their infection and thus not receiving treatment and care. Retention in care is essential to improve adherence and to monitor the health of people who are on HIV treatment correctly.
The consistent use of condoms remains necessary to prevent the transmission of other sexually transmitted infections as these are not prevented by HIV treatment or by using HIV pre-exposure prophylaxis .
What Else Can I Do To Prevent The Spread Of Hiv
- Take every dose of HAART medicines exactly as directed. This will prevent the virus from mutating and becoming much harder to treat. Consistent use of HAART medicines may help prevent the spread of HIV to a sex partner or an unborn baby.
- Join a risk reduction program. Ask your healthcare provider or local health department to help you find a risk reduction program. This program will teach you how to tell others that you have HIV and ask sex partners to use condoms.
- Treat STIs right away. If you are sexually active, get tested for STIs at least 1 time each year. If you become infected with an STI, treat it right away. This may help reduce the risk that you will give HIV to a sex partner.
What Are Some Of The Neurological Complications That Are Associated With Hiv Infection
AIDS-related disorders of the nervous system may be caused directly by the HIV virus, by certain cancers and opportunistic infections , or by toxic effects of the drugs used to treat symptoms. Other neuro-AIDS disorders of unknown origin may be influenced by but are not caused directly by the virus.
AIDS dementia complex , or HIV-associated dementia , occurs primarily in persons with more advanced HIV infection. Symptoms include encephalitis , behavioral changes, and a gradual decline in cognitive function, including trouble with concentration, memory, and attention. Persons with ADC also show progressive slowing of motor function and loss of dexterity and coordination. When left untreated, ADC can be fatal. It is rare when anti-retroviral therapy is used. Milder cognitive complaints are common and are termed HIV-associated neurocognitive disorder . Neuropsychologic testing can reveal subtle deficits even in the absence of symptoms.
Central nervous system lymphomas are cancerous tumors that either begin in the brain or result from a cancer that has spread from another site in the body. CNS lymphomas are almost always associated with the Epstein-Barr virus . Symptoms include headache, seizures, vision problems, dizziness, speech disturbance, paralysis, and mental deterioration. Individuals may develop one or more CNS lymphomas. Prognosis is poor due to advanced and increasing immunodeficiency, but is better with successful HIV therapy.
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Reducing Pill Burden With Single Tablet Regimens
In the early days of the HIV epidemic, high pill burden made successful adherence to treatment challenging. Selective non-adherence to a regimen increases the likelihood of developing resistance, which could limit future treatment options. STRs have revolutionized care by simplifying dosing and their impact has been profound and lasting. Today, clinical treatment guidelines from the US Department of Health and Human Services include certain STRs as recommended initial treatment regimen options for most people living with HIV. According to DHHS, factors that should guide the selection of a treatment regimen include virologic efficacy, toxicity, pill burden, dosing frequency, drug-drug interaction potential, resistance test results, comorbid conditions, access, and cost.
Target 6c: Have Halted By 2015 And Begun To Reverse The Incidence Of Malaria And Other Major Diseases
- Between 2000 and 2015, the substantial expansion of malaria interventions led to a 58 per cent decline in malaria mortality rates globally.
- Since 2000, over 6.2 million deaths from malaria were averted, primarily in children under five years of age in Sub-Saharan Africa.
- Due to increased funding, more children are sleeping under insecticide-treated bed nets in sub-Saharan Africa.
- Tuberculosis prevention, diagnosis and treatment interventions have saved some 37 million lives between 2000 and 2013.
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Rash Related To Medication
While rash can be caused by HIV co-infections, it can also be caused by medication. Some drugs used to treat HIV or other conditions can cause a rash.
This type of rash usually appears within a week or 2 weeks of starting a new medication. Sometimes the rash will clear up on its own. If it doesnt, a change in medications may be needed.
Rash due to an allergic reaction to medication can be serious.
Other symptoms of an allergic reaction include:
- trouble breathing or swallowing
Stevens-Johnson syndrome is a rare allergic reaction to HIV medication. Symptoms include fever and swelling of the face and tongue. A blistering rash, which can involve the skin and mucous membranes, appears and spreads quickly.
When 30 percent of the skin is affected, its called toxic epidermal necrolysis, which is a life threatening condition. If this develops, emergency medical care is needed.
While rash can be linked with HIV or HIV medications, its important to keep in mind that rashes are common and can have many other causes.
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How Hiv Treatment Works
HIV treatment does not cure HIV, but it stops the virus from reproducing in your body. It can reduce the amount of virus in the blood to undetectable levels, meaning that you cannot pass on HIV.
Treatment with anti-HIV drugs is sometimes called combination therapy because people usually take three different drugs at the same time often combined into one tablet.
It’s also known as antiretroviral therapy , or highly active antiretroviral therapy – HAART for short.
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Types Of Hiv Treatment
Over 25 anti-HIV drugs are now available, divided into six classes of drugs. Each class works against HIV in a particular way. The vast majority of people with HIV are put on a fixed dose combination pill.
Guidelines recommend several combinations, each best suited to specific health needs and lifestyle. The most important part of treatment is to take all your drugs in the right way at the right time, which is known as adherence.
The classes of anti-HIV drugs are:
- Nucleoside reverse transcriptase inhibitors .
- Nucleotide reverse transcriptase inhibitors .
- Non-nucleoside reverse transcriptase inhibitors .
- Protease inhibitors .
Goals Of Antiretroviral Therapy
The guidelines state that the primary goals of antiretroviral therapy are to maintain maximal suppression of the viral load , restore or preserve immunologic function, improve quality of life and reduce HIV-related morbidity and mortality. While a reduction in plasma viremia accounts for much of the clinical benefits of antiretroviral therapy, the guidelines note that the goal of suppressing viral replication as much as possible and for as long as possible must be balanced against the need to preserve effective treatment options. According to the guidelines, a strategy of switching to other antiretroviral regimens because of any detectable level of plasma viremia may rapidly exhaust the treatment options. In addition, the guidelines note that a favorable CD4 response can occur with incomplete suppression of the viral load. Thus, incomplete viral load suppression in the presence of sustained improvement in the CD4 count may not indicate a poor prognosis. This factor should be a consideration when evaluating the need to change antiretroviral therapy.
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What Is Hiv Treatment
HIV treatment involves taking highly effective medicines called antiretroviral therapy that work to control the virus. ART is recommended for everyone with HIV, and people with HIV should start ART as soon as possible after diagnosis, even on that same day.
People on ART take a combination of HIV medicines called an HIV treatment regimen. A person’s initial HIV treatment regimen generally includes three HIV medicines from at least two different HIV drug classes that must be taken exactly as prescribed. There are several options that have two or three different HIV medicines combined into a once-daily pill. Long-acting injections of HIV medicine, given every two months, are also available if your health care provider determines that you meet certain requirements.
The Benefits Of Hiv Treatment: Undetectable Means You Do Not Pass On The Virus
Since its introduction in the 1990s, the main aim of combination antiretroviral therapy for HIV has been to halt the progression of the infection, maintaining the health of the HIV-positive person taking treatment. In addition to this, the impact of treatment as prevention has been well described.
One outcome of an effective ART regimen is that it markedly supresses the amount of the virus circulating in the blood the so-called viral load to a very low level, so that the virus is no longer detectable during routine testing. Successful ART not only improves the health and lifespan of the person living with HIV and receiving treatment, but there is growing scientific consensus that effective ART, leading to viral suppression, also means that onward transmission of HIV is practically no longer possible.
In general, viral suppression, and with it an undetectable viral load, can be reached within six months of starting daily ART.
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Discontinued Or Interrupted Art
The updated guidelines now include information on discontinuation or interruption of long-acting ART, such as ibalizumab and the intramuscular formulations of cabotegravir and rilpivirine.
The update also explains the necessary steps to be taken before and during ART interruption for people who have HIV and are participating in a clinical trial where treatment interruptions occur.
Initiating Antiretroviral Therapy In Advanced Hiv Disease
Antiretroviral therapy is recommended in all patients with advanced HIV disease, which is defined as acquired immunodeficiency syndrome , and in all patients with symptomatic HIV infection, such as thrush or unexplained fever, but without AIDS. Because of the likelihood of concomitant disease, the choice of which antiretroviral agents to use in patients with advanced HIV disease must be made in light of potential drug interactions and overlapping drug toxicities. For example, protease inhibitors adversely affect the metabolism of rifampin, while rifampin reduces the blood level of protease inhibitors.
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What Else Should I Know
The two most important things you can do for your friend are to be there for support in whatever way feels natural and to keep your friends HIV diagnosis private. Just being there to hang out or eat lunch together can help keep things in perspective for everyone.
Life is for living. If friends know that you care about them for them â for the creative, smart, funny people they are â that can be the best thing you can do for a person living with any type of medical condition.
Hiv: Progress And Future Challenges In Treatment Prevention And Cure
Advances in care over the last 30 years have helped transform HIV from a fatal disease into a chronic, manageable condition for many people. Innovations in treatment and access are at the core of this progress. The advent of antiretroviral therapy , once-daily single tablet regimens with three medications combined into one pill, and many subsequent improvements in STRs combining efficacy and long-term safety represent some of the most significant milestones that have helped bring radical change in the outlook for people living with HIV.
Progress in treatment has been transformative, but significant gaps in care still remain. HIV continues to be a major global public health issue. In the United States, the South accounts for seven of the top ten states and nine of the top ten metropolitan areas with the highest rates of new infections. This is pointed evidence that the epidemic is ongoing for some communities., Globally, its estimated that more than 36 million people are living with HIV with acute challenges faced by Sub-Saharan Africa and many low- and middle-income countries. With the goal of reducing the individual and societal burden of HIV, prevention of new infections is as important as treating those who are living with HIV.
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What Is The Treatment For Hiv
The treatment for HIV is called antiretroviral therapy . ART involves taking a combination of HIV medicines every day.
ART is recommended for everyone who has HIV. ART cannot cure HIV, but HIV medicines help people with HIV live longer, healthier lives. ART also reduces the risk of HIV transmission.
What Are The Later Signs And Symptoms Of An Hiv Infection
You may feel well for months or years. As your CD4 count drops and your immune system weakens, you may develop signs such as oral thrush. An infection from a past virus, such as herpes or chickenpox, may come back. As your immune system continues to weaken, you can get more serious infections. You may develop the following:
- Chronic diarrhea or weight loss without trying
- White spots or hairy patches inside your mouth
- Trouble breathing, or a cough, with or without blood
- Fevers and night sweats
- Rash, blisters, bruises, or other skin changes
- Hair loss or vision loss
- Confusion and memory loss
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When Should You Start Hiv Medication
In general, medical professionals now believe the best chance for an HIV patient to protect and maintain their immune system health is to start aggressive treatment upon diagnosis in almost all cases. In the past, doctors thought that waiting until disease markers on blood tests reached a certain level could be better for the patients chances of survival and quality of life. Despite the potential danger of viral resistance and long-term drug side effects, studies have subsequently shown that starting antiviral medication early is the best option for nearly all people with HIV.
After 40 years of researching HIV/AIDS, clinicians, drug researchers, epidemiologists, and public health professionals have succeeded in making the virus much less deadly. Part of this effort included developing treatment guidelines about when, how, and under what conditions to initiate antiviral therapy to control the HIV infections.
AIDS is the end result of unchecked HIV infection. In other words, not all people with HIV have AIDS, but everyone with AIDS has HIV. AIDS describes the immune system collapse that opens the door for opportunistic infections and cancers. Without successful intervention, these secondary conditions typically kill the patient.
Goal : Reduce New Hiv Infections
- AIDS Education and Training Center partners with the Centers for Disease Control and Prevention to disseminate more widely Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States to health care providers.
- Building Futures for Youth Living with HIV assesses the current state of youth living with HIV aged 13-24 receiving Ryan White HIV/AIDS Program care and treatment, their unique barriers to care, and RWHAP providers capacity to engage and retain them in care with optimal health outcomes.
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What Conditions Make It Especially Important To Start Hiv Medicines Right Away
The following conditions make it especially important to start HIV medicines right away:
Pregnancy
All pregnant women with HIV should take HIV medicines to protect their health and prevent perinatal transmission of HIV. Women with HIV who become pregnant and are not already taking HIV medicines should start taking HIV medicines as soon as possible and throughout pregnancy. In most cases, women who are already on an effective HIV treatment regimen when they become pregnant should continue using the same regimen throughout their pregnancies.
The risk of perinatal transmission of HIV during pregnancy and childbirth is lowest when a woman with HIV has an undetectable viral load. Maintaining an undetectable viral load also helps keep the mother-to-be healthy.
Early HIV infection
Early HIV infection, also known as acute HIV infection, is the period up to 6 months after infection with HIV. During early HIV infection, a persons viral load is often very high.
Studies suggest that even at this early stage of HIV infection, HIV medicines can begin to protect a persons health. In addition, starting HIV medicines during early HIV infection reduces the risk of HIV transmission.
AIDS-defining conditions
Hiv Reports And Publications
The Health Department conducts HIV/AIDS surveillance in New York City. Surveillance involves investigating reports from providers and laboratories for HIV-related information and actively searching for unreported cases. The Health Department also conducts research on HIV prevalence, incidence and behavior in populations at risk for HIV. Find out more about HIV/AIDS in New York City with these reports and publications.
On December 1, World AIDS Day 2016, the NYC Health Department shared the HIV care performance results of New York City health care facilities. Combined, these facilities care for about half of the HIV-infected people in care in NYC. This information is now available on the NYC Health Departments HIV Care Continuum Dashboard.
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Adherence To Hiv Treatment
OW FONG
Drug adherence is a key part of highly active antiretroviral therapy . It refers to the whole process from choosing, starting, managing to maintaining a given therapeutic medication regimen to control HIV viral replication and improve function of the immune system. Non-adherence is the discontinuity or cessation of part or all of the treatment such as dose missing, underdosing, or overdosing, and drug holidays. The significance of adherence to treatment has become recognised, which is important in optimising the patient’s response to therapy. In contrast, non-adherence can lead to treatment failure, a rise in plasma viral load, and the development of drug-resistant HIV strains. This chapter is devoted to a description of a practical drug adherence programme, modeled on the protocol developed at the Integrated Treatment Centre, Department of Health.