HIV Treatment

Understanding HIV, Prevention, Care, and Treatment

In the United States multiple efforts are implemented to ensure that people living with HIV can live with HIV. Probably the single most important and powerful tool used to ensure that people living with HIV maintain some quality of life is HIV medication. These medications can often be complex and confusing to those struggling with medication options and understanding side effects. This section will look at what are medications, what types of medications exist, when should treatment begin, and how can medications be accessed.

HIV Medications

HIV medications are referred to be different names; the most common reference is "the cocktail." Upon hearing this, some may believe that a magical elixir exist that will take HIV away, but HIV medications do not work that way.

Quick Facts:

1. HIV medications are not a cure for HIV infection.
2. Individuals taking HIV medication may still spread the virus to others.
3. HIV medications reduce, but do not eliminate, the amount of virus in the body.
4. HIV medications may have side effects that range from annoying to severe and in some rare cases fatal.
5. Deciding to take HIV medications must be an agreement made between the patient and the doctor.
6. HIV medications must be taken according to doctor's orders for the best possible results.
7. Not taking HIV medications according to doctor's orders may cause drug resistance.

Antiretroviral Therapy

Antiretroviral therapy refers to the medications used to combat HIV. HIV is a retrovirus and medications are used to slow the growth of the virus at different stages. To understand how antiretroviral therapy works, first an overview of the HIV life cycleⁱ is needed.

Steps in HIV Life Cycle

1. Free virus circulates in the bloodstream.
2. HIV attaches to a cell.
3. HIV empties its contents into the cell (infects the cell).
4. The HIV genetic code (RNA) is changed into DNA by the reverse transcriptase enzyme.
5. The HIV DNA is built into the infected cell's DNA by the integrase enzyme.
6. When the infected cell reproduces, it activates the HIV DNA, which makes the raw material for new HIV viruses.
7. Packets of material for a new virus come together.
8. The immature virus pushes out of the infected cell in a process called "budding."
9. The immature virus breaks free of the infected cell.
10. The new virus matures: raw materials are cut by the protease enzyme and assembled into a functioning virus.

Different classes of HIV medications exist to try and stop the virus at different points in the life cycle. Currently there are only 4 classes of HIV medications.ⁱⁱ The 4 classes are as follows:

• Nucleoside reverse transcriptase inhibitors ("nukes"): block Step 4, where the HIV genetic material is converted from RNA into DNA.
• Non-nucleoside reverse transcriptase inhibitors: also block Step 4, but in a different way.
• Protease inhibitors ("PIs"): block Step 7, where the raw material for new HIV virus is cut into specific pieces.
• The newest class of antiviral drugs includes fusion and attachment inhibitors They prevent HIV from attaching to a cell by blocking Step 2 of the life cycle.

Available Drugs to Treat HIV

The U.S. Food and Drug Administration approves medications in the United States the following HIV medications are approved to treat HIV and complications of HIV infection.

Drugs Used in the Treatment of HIV Infection, 2004ⁱⁱⁱ

Nucleoside reverse transcriptase inhibitors

Non-nucleoside reverse transcriptase inhibitors

Protease inhibitors

Attachment and Fusion inhibitors

Drugs Used to Treat Complications of HIV/AIDS, 2004^iv

Drugs Used in the treatment of Pediatric HIV Infection^v

Nucleoside reverse transcriptase inhibitors

Non-nucleoside reverse transcriptase inhibitors

Protease inhibitors

Attachment and Fusion inhibitors
None at this time.

Test Positively Aware Network (TPAN) has developed the 2004 HIV Drug Chart that details the drug with its recommended dosage and food restrictions.

Side Effects of HIV Treatment

Side effects are what drugs do that you don't want them to do. All medications have specific purposes, but many may have mild (slight headache) to severe (liver damage) side effects because of the medication. HIV medications may have the following side effects:

• Fatigue
• Anemia
• Loss of appetite
• Gas and bloating
• Diarrhea
• Lipodysthropy (redistribution of fat in the body)
• Skin problems (e.g. rashes, dry skin, hair loss)
• Neuropathy (painful nerve condition)
• Mitochondrial Toxicity
• Bone problems

These side effects may happen but remember:

• Don't assume that you will get every side effect that's listed!
• Do not stop taking any of your medications, or skip or reduce your dose, without talking to your doctor!
• Before side effects make you skip or reduce doses, talk to your doctor about changing drugs!
• Don't let side effects stop you from taking your medication!

For a detail listing of current HIV drugs and their potential side effects go to: AIDS Infonet - Fact Sheet 401: Taking Current Antiviral Drugs http://www.aidsinfonet.org/articles.php?articleID=401

When should I begin treatment?

The current clinical guidelines for beginning treatment are CD4+ T-cell counts £ 350 or viral loads > 55,000 copies/mL.^vi It is import for people living with HIV to discuss with medical providers potential concerns about cost, side effects, and adherence to medication. All of these should be taken into consideration before beginning HIV treatment because the medications will only work as well as the person takes them. When beginning medications some people have found it helpful to work with adherence coaches or mental health professionals. Ask the doctor about options available.

What is an AIDS Clinical Trial?

AIDS Clinical Trails are a part of the approval process for medication to treat HIV disease, as mandated by the Food and Drug Administration (FDA). The FDA approves new drugs and other treatments based on the results of laboratory tests, animal tests, and tests in humans (clinical trials). The trial itself is a carefully planned and monitored medical experiment that has stringent protocols to maintain the safety of client. There are benefits and risks to which are detailed below:

* Some trials must be done with placebo (i.e. sugar pill) to ensure that the effect of treatment is what doctors believe it to be. Patients still receive medical monitoring and lab test.

There are strict laws on research using human participants. The main tool to protect you is called "Informed Consent". You will be given a full, written description of the clinical trial to read and sign before you agree to participate. Take your time to review the Informed Consent before you sign it. If you need an interpreter to help you understand it, ask for one. If you have questions, be sure you get the answers before you sign. Also local and national boards review and monitor each clinical trial before it starts and while in progress. Trials can be stopped early if they are harming participants. You can decide to drop out of a clinical trail at any time, for any reason.

More information on clinical trials can be found at:

• AIDS Info Net - Fact Sheet 205 - Participating in a clinical trial - http://www.aidsinfonet.org/articles.php?articleID=205
• For information about participating in clinical trials or trials availability throughout the US, call the AIDSinfo Health Information Service at 1-800-448-0440, or visit their Internet web site at http://aidsinfo.nih.gov
• The FDA website has information on the drug development process at http://www.fda.gov/cder/handbook/dev_rev.htm

Missouri is also fortunate to have an AIDS Clinical Trial Unit (ACTU) housed at Washington University School of Medicine in St. Louis, MO. Since 1987, the Washington University ACTU has been a highly productive participant in the AIDS Clinical Trials Group funded by the National Institute of Allergy and Infectious Diseases. It conducts clinical research trials of potential treatments for HIV and its complications. Centrally located in the Midwest, the Washington University ACTU draws participants from Missouri, Illinois, Arkansas, Kansas, Tennessee, Nebraska and Oklahoma. With close ties to the Division of Infectious Diseases at Washington University School of Medicine, this ACTU is among the finest in the world. For more information check out their website at http://actu.im.wustl.edu/.

What resources are available?

More information on treating HIV can be found at the following links:

The New Mexico AIDS Infonet - Medications to Fight HIV http://www.aidsinfonet.org/topic_index.php?category=400&subcategory=true#400.400

The Body.com - HIV Medications: When to Start and What to Take - A Roadmap to Success http://www.thebody.com/hivmed/contents.html

Test Positive Aware Network http://www.tpan.com

Young People may want to look at the Thrive Guide produced by San Francisco's Health Initiatives for Youth (HIFY). The Thrive Guide is available online at www.whatudo.org