Human immunodeficiency virus, or HIV, is the lentivirus that ultimately results in the development of acquired immune deficiency syndrome (AIDS). Like other infectious diseases, HIV is closely monitored by the Department of Health in an attempt to find the best methods of treatment and track progress. While the disease is still existent, great strides have been made in the past two decades in extending life expectancies and improving condition symptoms. Life expectancies for antiretroviral medication users have increased 15 years since 2002 with patients now living until 71 years of age.
The transmission of HIV most frequently occurs through unprotected sex and the sharing of syringes. Men who have sex with men are presently in the increased risk group. Other risk groups include partners that have sex with a man who has had sex with men, drug users that share syringes, needles or other injection devices or patients that have received a blood transfusion in a country that does not screen for HIV. This disease can also be spread from mother to child during pregnancy, childbirth or breast feeding, unprotected oral sex or the exposure to HIV positive blood through accidental needle stick in a healthcare setting.
The virus cannot live outside the body and therefore cannot be spread through social contact such as hugging, shaking hands or sharing common items such as dishes, remotes, etc. Casual kissing also will not spread HIV.
Antiretroviral medications have seen the most progress and improvement than any other method of treatment for HIV. Several of these drugs are used together in antiretroviral therapy (ART) to suppress the virus and stop further progression of the disease. Doing so also prevents the genetic mutations from building drug resistance. These medications are administered through a series of pills taken every day. When antiretroviral drugs are used incorrectly, drug resistant strains of HIV can develop very rapidly and become the dominant genotype infecting many cells.
Current antiretroviral medications on the market include:
- Entry/Fusion Inhibitors – Entry, or fusion, inhibitors are AIDS drugs that help suppress HIV by blocking it from attaching to a host cell. Examples are: Fuzeon, Selzentry, Cenicriviroc, and Ibalizumab.
- Nucleoside/Nucleotide Reverse Transcriptase Inhibitors – NRTIs/NtRTIs work by obstructing the HIV replication process with false HIV DNA. Examples are: Emtriva, Combivir, Epzicom, Truvada, and Viread.
- Non-Nucleoside Reverse Transcriptase Inhibitors – NNRTis incapacitate the reverse transcriptase enzyme which is necessary for making HIV DNA. Examples are: Edurant, Intelence, Rescriptor, and Sustiva.
- Integrase inhibitors – Integrase is another necessary enzyme that is used by HIV to “hijack” host cell DNA for replication. Examples are: Isentress, Dolutegravir, and Elvitegravir.
- Protease inhibitors – Inhibits HIV protease, an enzyme used to cut HIV proteins before they are used for new HIV particles. Examples are: Aptivus, Crixivan, Invirase, and Kaletra
The size of the pills, some exceeding 1,000 milligrams, often discourages patients from taking them on schedule. Fixed-dose combinations have also been developed to encourage patients to stay on track with medication and reducing the risk of contracting opportunistic viruses while their immune system is compromised. These medications include:
- Combivir – zidovudine + lamivudine [icon name=”icon-arrow-right”]GlaxoSmithKline
- Trizivir – abacavir + zidovudine + lamivudine [icon name=”icon-arrow-right”]GlaxoSmithKline
- Kaletra – Lopinavir + ritonavir [icon name=”icon-arrow-right”]Abbott Laboratories
- Epzicom – Abacavir + lamiivudine [icon name=”icon-arrow-right”]GlaxoSmithKline
- Atripla – Efavirenz + tenofovir/emtricitabine [icon name=”icon-arrow-right”]Gilead Sciences and Bristol-Myers Squibb
After beginning an ART regimen, it is not uncommon for a patient to develop a resistance towards medications. HIV develops through replication and during this replication process they may develop slight changes in the structure called a mutation. When an HIV has a mutation in an area that is targeted by antiretroviral medications then that generation is less impacted by the drug and could potentially survive against it. Resistance often requires changes in the drug regimen by increasing dosages, changing medications or using a different method altogether.
Drug Combination Side Effects
Antiretroviral medications, like many other medications, may have some side effects that vary from mild to severe and can be short term or have lasting effects. One’s medication regimen is dependent largely on a patient’s willingness to live with these side effects for the sake of progress against HIV. IF side effects remain persistent, doctors recommend changing dosages, treating the side effect itself or changing treatment regimen. Short term side effects can include, but are not limited to, fatigue, anemia, nausea, vomiting, dizziness, insomnia, pain or nerve problems, dry mouth and weight loss.
While some side effects may last indefinitely, there are ways to manage them and make them less troublesome. Some of the most common long term side effects are:
- Fat redistribution – also known as lipodystrophy, medications can change the way the body uses and stores fat. Some people begin to notice fat in areas that had never been affected, such as the neck and arms, when they usually gain it in the abdomen and legs.
- Increases in cholesterol – Diet and other lifestyle changes can often combat the risks associated with increased cholesterol such as heart disease. If the condition is persistent, doctors may prescribe fibrates and statins.
- Elevated blood sugar levels – Like cholesterol, blood sugar levels can be managed through diet changes and exercise
- Decreased bone density – Bone loss can increase a patient’s risk of fractures so one should stay active and trying walking, running, and weight lifting to increase muscular support. Doctors may also prescribe calcium supplements.
Early detection can greatly decrease a person’s chances of developing AIDS if a treatment regimen is starting promptly. Many local and government agencies offer low cost and free HIV testing in an effort to prevent the spread of the disease. A person may show a negative reading during the “HIV window period”, or the time between infection and a positive test result. This time frame can vary from 9 days to 6 months depending on the extent of the exposure, a person’s body type and the type of test used. It is recommended that people with multiple sex partners get tested regularly.
Modern technology has allowed for several different methods of testing and these are offered in various testing centers across the country. The Centers for Disease Control and Prevention (CDC) offers many resources to those looking for more information on testing, prevention and treatment.