Lifestyle Changes And Complementary Treatments
A healthy lifestyle can ease some of the effects of HIV or its treatment:
- Stick to a balanced diet. Energy and nutrients help your body fight HIV. A healthy diet may also let your medications work better and could ease side effects. But be careful to prevent foodborne illness by avoiding raw meat and eggs.
- Get regular exercise. It boosts strength and endurance, lowers your risk of depression, and helps your immune system work better.
- Donât smoke. Smoking can make you more likely to get a serious condition like cancer, pneumonia, heart disease, or chronic obstructive pulmonary disease . People with HIV who smoke tend to have shorter lifespans than those who donât.
- Get your vaccinations. Ask your doctor about whether they recommend that you get vaccines against pneumonia, flu, hepatitis A or B, or HPV.
Some people say that complementary therapies — those done in addition to standard medical treatment — help them feel better and live fuller lives with HIV. These may include:
Always talk with your doctor before adding a traditional practice or nutritional supplement to your HIV treatment plan.
How Do Hiv Medicines Work
HIV attacks and destroys the infection-fighting CD4 cells of the immune system. Loss of CD4 cells makes it hard for the body to fight off infections and certain HIV-related cancers.
HIV medicines prevent HIV from multiplying , which reduces the amount of HIV in the body . Having less HIV in the body gives the immune system a chance to recover and produce more CD4 cells. Even though there is still some HIV in the body, the immune system is strong enough to fight off infections and certain HIV-related cancers.
By reducing the amount of HIV in the body, HIV medicines also reduce the risk of HIV transmission. A main goal of HIV treatment is to reduce a persons viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partners through sex.
What Types Of Antiretrovirals Might I Be Prescribed
Types of antiretrovirals include:
- integrase inhibitors
- entry inhibitors
If you have HIV, youll usually be prescribed a few different antiretrovirals at the same time at least 3 medicines from at least 2 of the 5 classes. This is known as combination therapy. Some HIV medications are single pills that combine more than one medicine. Sometimes you might be given 1 or 2 different pills, but these can actually be 3 different medicines.
As well as antiretrovirals, your treatment can include medicines to guard against infections, as your immune system may no longer be able to fight them.
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How Hiv Treatment Works
Antiretroviral treatment means taking antiretroviral drugs to keep HIV at very low levels in your body. It protects your immune system so that you can stay healthy and live a long life.
People with HIV should start treatment straight away. But some people may need time to process their diagnosis before they feel ready.
There are lots of different antiretroviral drug combinations. Your healthcare worker will help you find the right one for you.
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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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 .
Rapid Art Initiation & Restart: Guide For Clinicians
Immediate antiretroviral therapy means starting HIV treatment as soon as possible after the diagnosis of HIV infection, preferably on the first clinic visit . This strategy also is known as rapid ART, same-day ART, and treatment upon diagnosis.
Immediate ART initiation may bring earlier benefits in personal health, and earlier reductions in the risk of onward transmission of HIV. For persons with acute infection, immediate ART may limit the HIV viral reservoir.
This Clinicians Guide is a distillation of best practices for immediate ART initiation and is based on resources from San Franciscos Getting to Zero RAPID program and San Francisco General Hospitals RAPID program.
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How Can Hiv Care Providers Help Patients Address Barriers To Art Adherence
Brief conversations with patients can help HIV care providers identify and utilize teachable moments. Numerous studies show that through open discussion, HIV care providers and patients can uncover barriers, identify strategies, and set behavioral goals to improve adherence. 2,3,4,5 Following are some suggestions for how HIV care providers may address barriers to ART adherence as they arise:
When discussing patient beliefs and behaviors:
- Explain the importance of consistent ART adherence even when viral load is undetectable.
When addressing cognitive barriers:
- Offer advice about and tools for adherence, such as weekly pill boxes, linking dosing to daily events/activities, and dose reminder alarms.
- Use a feedback strategy to help patients avoid confusion about new medicines and/or changed regimen.
To assist with competence issues:
When addressing comorbid conditions:
- Regularly review total treatment plan, and simplify regimen, if possible, with consideration for patients lifestyles and comorbidities.
- Anticipate possible drug-drug interactions.
When discussing regimen-related barriers:
To assist with psychosocial barriers:
- Offer referrals to and/or information about mental health, substance use, and other support resources .
- Remind patients not to share their ART with anyone.
To help mitigate structural barriers:
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.
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Benefits And Risks Of Art
Lead authors: Asa Radix, MD, MPH, and Noga Shalev, MD, with the Medical Care Criteria Committee updated August 11, 2022
Benefits and Risks of ART
Antiretroviral therapy refers to the use of pharmacologic agents that have specific inhibitory effects on HIV replication. The use of fewer than three agents is not recommended for initiating rapid treatment. These agents belong to six distinct classes of drugs: the nucleoside and nucleotide reverse transcriptase inhibitors , the non-nucleoside reverse transcriptase inhibitors , the protease inhibitors , the fusion inhibitors , the CCR5 co-receptor antagonists, and the integrase strand transfer inhibitors . See all commercially available antiretroviral drugs that are approved by the U.S. Food and Drug Administration for the treatment of HIV/AIDS.
How Should I Take My Antiretroviral Treatment
Most antiretroviral drugs are taken once a day, but others are taken twice a day. There will be instructions about whether you should take them with or without food. Once you start ART its very important that you take it properly and dont miss or skip doses. If you do, this can lead to HIV drug resistance which is when your drugs dont work as well.
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What Is An Hiv Treatment Regimen
An HIV treatment regimen is a combination of HIV medicines used to treat HIV infection. HIV treatment begins with choosing a regimen. People on ART take the HIV medicines in their HIV regimens every day. ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.
The U.S. Food and Drug Administration has approved more than 30 HIV medicines to treat HIV infection. Some HIV medicines are available in combination .
HIV medicines are grouped into seven drug classes according to how they fight HIV.
Prevention Of Sexual Transmission
A randomized clinical trial3 and several large observational cohort studies4-6 have provided strong evidence that achieving sustained viral suppression prevents sexual transmission of HIV. Thus, a key goal of ART is to prevent transmission of HIV to seronegative sexual partners . All persons with HIV should be informed that maintaining a plasma HIV RNA of < 200 copies/mL, including any measurable value below this threshold value, with ART prevents sexual transmission of HIV to their partners . Patients may recognize this concept as Undetectable = Untransmittable, or U=U. The results of these studies are summarized in Antiretroviral Therapy to Prevent Sexual Transmission of HIV.
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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 .
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.
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What Are The Side Effects Of Antiretrovirals
If youre taking antiretrovirals, you may experience no side effects, or you may have side effects such as diarrhoea, headaches, nausea and stomach ache. Your doctor can help you manage these side effects, and they often decrease after the first month.
You may develop long-term side effects, such as nerve damage causing hand and foot pain, high cholesterol, high blood sugar, change in body shape , liver or kidney damage, anaemia, mouth ulcers, or mood changes.
Your doctor can help you manage any long term side effects, with changes in diet or lifestyle or with new medicines.
How Can Hiv Care Providers Determine If A Patient Is Ready To Begin Art
Recent findings show that assessing a patients ART readiness is the first step to successful ART adherence. 6 Patients starting ART should be willing and able to commit to treatment and understand the benefits and risks of therapy and the importance of adherence.
Before patients begin ART, health care providers can evaluate patient readiness to help identify predictors of suboptimal adherence 5,6 HIV care providers can enhance communication with patients by asking several open-ended questionsquestions that cannot be answered with a simple yes or no. 6 Following are some examples of questions probing ART readiness:
- What have you heard about HIV medicines?
- What are the most important results you hope to gain from treatment?
- What are your concerns about HIV medicines?
Objectivity and a nonjudgmental attitude are important. Health care providers can make it clear that even if they do not share patients views, they respect them. By understanding and respecting patients views, HIV care providers have the opportunity to improve the patient-health care provider relationship and make the patient more likely to be open and adherent.
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Rapid Art Initiation Is Safe
In the San Francisco study discussed above , 89.7% of patients used integrase strand transfer inhibitor -containing regimens and 12.8% used protease inhibitor-containing regimens. The predominant INSTI-based regimen was dolutegravir plus emtricitabine/tenofovir disoproxil fumarate. The clinic did not have any cases of major resistance mutations to the prescribed ART regimen, and no regimen switches were made because of resistance. Two patients had their regimens changed because of rash, and in 10 cases, the regimen was simplified to a single-tablet regimen.
Of 149 patients initiating ART through a program in New York City, only 1 required a regimen change because of subsequently detected resistance .
Rapid ART initiation is safe. Most designated regimens for rapid ART initiation are the same regimens that are recommended as initial treatment in the existing NYSDOH, International Antiviral SocietyUSA, and DHHS guidelines. These regimens are well-tolerated and effective, and the likelihood of drug resistance is low based on the current prevalence of drug resistance .
Amanyire G, Semitala FC, Namusobya J, et al. Effects of a multicomponent intervention to streamline initiation of antiretroviral therapy in Africa: a stepped-wedge cluster-randomised trial. Lancet HIV 2016 3:e539-e548.
CDC. Understanding the HIV care continuum. 2018
NYCDHMH. HIV surveillance annual report, 2017. 2018
What Factors Are Considered When Choosing An Hiv Treatment Regimen
When choosing an HIV treatment regimen, people with HIV and their health care providers consider the following factors:
- Other diseases or conditions that the person with HIV may have, such as heart disease or pregnancy.
- Possible side effects of HIV medicines.
- Potential interactions between HIV medicines or between HIV medicines and other medicines the person with HIV is taking.
- Results of drug-resistance testing . Drug-resistance testing identifies which, if any, HIV medicines will not be effective against a persons HIV.
- Convenience of the treatment regimen. For example, a regimen that includes two or more HIV medicines combined in one pill is convenient to follow.
- Any issues that can make it difficult to follow an HIV treatment regimen. For example, a lack of health insurance or an inability to pay for HIV medicines can make it hard to take HIV medicines consistently every day.
The best HIV treatment regimen for a person depends on their individual needs.
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Immediate Antiretroviral Therapy Initiation On The Day Of Hiv Diagnosis
Since individuals may fail to engage in care between the initial HIV diagnosis and the time ART is prescribed, some groups have proposed rapid ART initiation on the same day of HIV diagnosis as a strategy to increase ART uptake and engagement in care and to accelerate the time to ART-mediated viral suppression. Rapid ART initiation also has the potential to reduce the time during which people with newly diagnosed HIV can transmit HIV. The rapid ART initiation strategy is supported by randomized controlled trials that were performed in resource-limited settings outside of the United States27-29 and observational trials in the United States that included both immediate initiation of ART 30-32 and rapid ART initiation .32,33 The results from some of these studies are discussed below.
There are many differences between health care in southern Africa and Haiti and in the United Statesincluding differences in the health care systems, structural barriers to engagement in care, underlying HIV and tuberculosis epidemics, and ART regimens usedthat limit the generalizability of the findings of the results from the studies described above. These studies, however, suggest that same-day initiation of ART is feasible and could potentially improve clinical outcomes.
Whats The Difference Between Viral Load And Cd4 Count
Your viral load is how much of the HIV virus is in your blood.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.
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.
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