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 .
When Is It Time To Start Taking Hiv Medicines
People with HIV should start taking HIV medicines as soon as possible after an HIV diagnosis. It is especially important for people with AIDS-defining conditions or early HIV infection to start HIV medicines right away.
Women with HIV who become pregnant and are not already taking HIV medicines should also start taking HIV medicines as soon as possible.
Initiation Of Antiretroviral Therapy
Antiretroviral drug treatment guidelines have changed over time. Before 1987, no antiretroviral drugs were available and treatment consisted of treating complications from opportunistic infections and malignancies. After antiretroviral medications were introduced, most clinicians agreed that HIV positive patients with low CD4 counts should be treated, but no consensus formed as to whether to treat patients with high CD4 counts.
In April 1995, Merck and the National Institute of Allergy and Infectious Diseases began recruiting patients for a trial examining the effects of a three drug combination of the protease inhibitor indinavir and two nucleoside analogs. illustrating the substantial benefit of combining 2 NRTIs with a new class of antiretrovirals, protease inhibitors, namely indinavir. Later that year David Ho became an advocate of this “hit hard, hit early” approach with aggressive treatment with multiple antiretrovirals early in the course of the infection. Later reviews in the late 90s and early 2000s noted that this approach of “hit hard, hit early” ran significant risks of increasing side effects and development of multidrug resistance, and this approach was largely abandoned. The only consensus was on treating patients with advanced immunosuppression . Treatment with antiretrovirals was expensive at the time, ranging from $10,000 to $15,000 a year.
Treatment as prevention
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Whats The Difference Between Viral Load And Cd4 Count
Viral load
Your viral load is how much of the HIV virus is in your blood.â¯The aim of HIV treatment is to lower your viral load and then to keep it as low as possible. WHO recommends that you have a viral load test at 6 and 12 months after you start taking treatment, and then once a year. If treatment is started early enough and followed correctly, your viral load can become undetectable within six months. This is when your viral load is less than 200 copies/ml which shows that your treatment is working very well.
In some countries, viral load testing is not available. If this is the case where you are, your healthcare professional will monitor your health in other ways.
CD4 count
Your CD4 count shows the strength of your immune system. CD4 cells, an important part of your immune system, are attacked by the HIV virus. When you start taking treatment the number of CD4 cells you have will go up. A CD4 count over 500 is a sign that your immune system is recovered. If you were feeling ill because of HIV, you should start to feel better.â¯
What Is Antiretroviral Treatment
Antiretroviral treatment is also known as antiretroviral therapy or ART. It is the medication that treats HIV. It involves taking antiretroviral drugs . Treatment is not a cure for HIV â it does not remove HIV from your body completely. But it does keep HIV at very low levels so it doesnât affect your health.
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How Do Hiv/aids Medicines Work
HIV/AIDS medicines reduce the amount of HIV in your body, which helps by:
- Giving your immune system a chance to recover. Even though there is still some HIV in your body, your immune system should be strong enough to fight off infections and certain HIV-related cancers.
- Reducing the risk that you will spread HIV to others
Highly Active Antiretroviral Therapy
In 1996, highly active antiretroviral therapy was introduced for people with HIV and AIDS. HAART â often referred to as the anti-HIV “cocktail” â is a combination of three or more drugs, such as protease inhibitors and other anti-retroviral medications. The treatment is highly effective in slowing the rate at which the HIV virus replicates itself, which may slow the spread of HIV in the body. The goal of HAART is to reduce the amount of virus in your body, or the viral load, to a level that can no longer be detected with blood tests.
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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 .
Does Hiv Treatment Cause Side Effects
Like most medicines, HIV medicines can cause side effects in some people. However, not everyone experiences them. The HIV medicines used today have fewer side effects and are less severe than in the past. Side effects can differ for each type of HIV medicine and from person to person. Some side effects can occur once you start a medicine and may only last a few days or weeks. Other side effects can start later and last longer.
Side effects of HIV medicine most commonly reported include:
- Nausea and vomiting
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Other Hiv Management Considerations
Behavioral and psychosocial services are integral to caring for persons with HIV infection. Providers should expect persons to be distressed when first informed that they have HIV. They face multiple adaptive challenges, including coping with the reactions of others to a stigmatizing illness, developing and adopting strategies to maintain physical and emotional health, initiating changes in behavior to prevent HIV transmission to others, and reducing the risk for acquiring additional STIs. Many persons will require assistance gaining access to health care and other support services and coping with changes in personal relationships.
Persons with HIV infection might have additional needs . Others require assistance to secure and maintain employment and housing. Persons capable of reproduction might require family planning counseling, information about reproductive health choices, and referral for reproductive health care.
The following recommendations apply to managing persons with diagnosed HIV infection:
Favorite Information On Nutrition For Hiv
If youre living with HIV, nutrition is vital for your long-term health and well-being. The Well Project, a nonprofit that focuses on women with HIV and AIDS, offers resources on how to incorporate the ideal foods for optimal health. Youll find information on how to fight weight and muscle loss, keep your energy levels high, and minimize side effects from HIV medication.
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What Is U=u And What Does It Mean For Me
U=U stands for Undetectable = Untransmittable.
U=U is a public health campaign to spread the message that if your blood tests show you have no detectable HIV then you cant infect anyone else with HIV .
The best way to keep your HIV viral load at an undetectable level is by taking your antiretroviral medicines exactly as prescribed.
If your HIV viral load is undetectable, then you can have sexual intercourse with no risk of spreading HIV to your partner. Its still important to remember that unprotected intercourse still puts you at risk of catching or passing on other sexually transmitted infections .
Research And Statistics: How Many People Have Hiv/aids
In 2019, close to 37,000 people were diagnosed with HIV in the United States, according to the latest figures available from the CDC. The annual number decreased by approximately 9 percent between 2015 and 2019.
The CDC further estimates that roughly 1.2 million people in the United States were living with HIV at the end of 2019, and that about 13 percent of those individuals were unaware they were HIV-positive.
Anyone can acquire HIV, but the prevalence of HIV is not the same in all communities and varies depending on social and demographic factors.
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
Reviewing And Abstracting The Articles
Determining which articles identified in the literature searches were to be included in the review involved a number of steps:
- First, the titles of articles for each of the questions received independent dual review by two of the authors, with copies obtained of any abstracts suggested by either one of them.
- Copies of the abstracts were reviewed by two of the authors.
- Articles were identified for abstraction only when both reviewers agreed. The abstracts of all of the excluded articles were independently reviewed by another of the authors to ensure that no articles were incorrectly excluded from the review.
- Eligible articles were given to one of three trained abstractors who extracted the data to be included in the evidence tables using specially designed forms.
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Medications Recommended As Initial Hiv Treatment In Certain Situations
If the combinations listed above are not suitable for you, or in some other clinical situations, other drugs may be used. As before, a backbone of tenofovir and emtricitabine is recommended. A third medication may be added:
Darunavir. This is a protease inhibitor, which is boosted with ritonavir or cobicistat. It is included in the tablets Prezista, Rezolsta and Symtuza, or from generic manufacturers.
Raltegravir. This is an integrase inhibitor, available in a tablet called Isentress. Both once-a-day and twice-a-day doses are available.
Doravirine. This is a non-nucleoside reverse transcriptase inhibitor . It is included in the tablets Pifeltro and Delstrigo.
Efavirenz. This is a non-nucleoside reverse transcriptase inhibitor, available from generic manufacturers. In some circumstances, the backbone could be abacavir and lamivudine, rather than tenofovir and emtricitabine. Efavirenz is only recommended for people who are pregnant or taking tuberculosis treatment.
Favorite Hiv Home Testing Resources
Need to take an STD test, but dont want to leave your home? myLab Box offers kits that screen for STDs like HIV, chlamydia, gonorrhea, HPV, and more. Depending on the test, youll mail in a small sample of urine, a vaginal swab, or a prick of blood, and youll get your results in one to five days.
Testing couldnt be any more convenient. This in-home HIV test is approved by the FDA and doesnt require sending a sample to a lab. You can test yourself in the privacy of your own home with an oral swab. The kit gives you a result in 20 to 40 minutes.
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Will I Develop Resistance To Medication
If you skip doses of your HIV drugs regularly, you might develop resistance to the medicine, which means the medicine wont work on you as well as it should.
Your doctor can help lower your chance of resistance to HIV medicines by choosing effective medicines and by using a combination of medicines instead of just one. You can help lower your chances of developing resistance by taking each dose on time.
If you do develop resistance, your doctor may start you on different medicines, or recommend a combination of more than 3 medicines.
Tell your doctor if you are concerned about your symptoms never stop or change your medicine on your own.
How Are Hiv And Aids Treated
The most effective treatment for HIV is antiretroviral therapy . This is a combination of several medicines that aims to control the amount of virus in your body. Antiretroviral medicines slow the rate at which the virus grows. Taking these medicines can reduce the amount of virus in your body and help you stay healthy.
After you start treatment, it’s important to take your medicines exactly as your doctor tells you. When treatment doesn’t work, it is often because HIV has become resistant to the medicine. This can happen if you don’t take your medicines correctly.
Other steps you can take include the following:
- Keep your immune system strong by eating right, quitting smoking, and learning how to avoid infection.
- Monitor your CD4+ counts to check the effect of the virus on your immune system.
- See a counselor to help you handle the strong emotions and stress that can follow an HIV diagnosis.
- Reduce stress so that you can better manage the HIV illness.
Starting treatment
Medical experts recommend that people begin treatment for HIV as soon as they know that they are infected. Treatment is especially important for pregnant women, people who have other infections , and people who have symptoms of AIDS.
Research suggests that treatment of early HIV with antiretroviral medicines has long-term benefits, such as a stronger immune system.
Treatment to prevent HIV infection
Other treatments for HIV
Treatment for AIDS
Living with HIV
If your partner has HIV:
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Why Is Hiv Treatment Important
If taken as prescribed, HIV medicine reduces the amount of HIV in your blood to a very low level, which keeps your immune system working and prevents illness. This is called viral suppression, defined as having less than 200 copies of HIV per milliliter of blood.
HIV medicine can also make your viral load so low that a standard lab test cant detect it. This is called having an undetectable level viral load. Almost everyone who takes HIV medicine as prescribed can achieve an undetectable viral load, usually within 6 months after starting treatment. Many will bring their viral load to an undetectable level quickly, but it could take more time for a small portion of people just starting HIV medicine.
There are important health benefits to getting the viral load as low as possible. People with HIV who know their status, take HIV medicine as prescribed, and get and keep an undetectable viral load can live long and healthy lives.
There is also a major prevention benefit. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load will not transmit HIV to their HIV-negative partners through sex. Learn more about the prevention benefits of having an undetectable viral load.
HIV treatment is most likely to be successful when you know what to expect and are committed to taking your medicines exactly as prescribed. Working with your health care provider to develop a treatment plan will help you learn more about HIV and manage it effectively.
Keep Your Viral Load Undetectable
HIV treatment is not a cure and HIV is still in your body, even when your viral load is undetectable, so you need to keep taking your HIV medicine as prescribed. If you skip doses of your HIV medicine, even now and then, you give HIV the chance to multiply rapidly. This could weaken your immune system, and you could become sick.
If you have stopped taking your HIV medicine or are having trouble taking all the doses as prescribed, talk to your health care provider as soon as possible. Your provider can help you get back on track and discuss the best strategies to prevent transmitting HIV to your sexual partners until your viral load is confirmed to be undetectable again.
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Medications Recommended As Initial Treatment For Most People Living With Hiv
The recommended first-line HIV treatments for most people all include an integrase inhibitor: either dolutegravir or bictegravir. It is usually taken together with a nucleotide backbone as part of a three-drug combination.
There are five options:
Dolutegravir / tenofovir disoproxil / emtricitabine. This is usually taken as two pills: Tivicaycontains dolutegravir, and a pill from a generic manufacturer contains the other two drugs.
Dolutegravir / tenofovir alafenamide / emtricitabine. This is usually taken as two pills: Tivicaycontains dolutegravir, while Descovy contains the other two drugs.
Dolutegravir / abacavir / lamivudine. This is usually taken as one pill, called Triumeq.
Dolutegravir / lamivudine. This combination includes two drugs, not three. It is usually taken as one pill, called Dovato.