66. How is HIV infection treated?

Treatment for HIV infection includes:

• Highly Active Anti-Retroviral Treatment (HAART);

• preventive treatment to avoid opportunistic infections;

• treatments for HIV-related illnesses; and

• healthy living practices.

HAART (Highly Active Anti-Retroviral Therapy) involves taking three or more drugs that fight HIV at the same time. HAART can strengthen the immune system and reduce the amount of HIV in the blood. Many medicines are available, and no one combination is best for everyone. Not everyone with HIV needs HAART, which is usually started only when signs of immune system damage or symptoms of HIV appear.

Drugs that fight HIV are divided into several “classes” or types. The different classes of drugs are used in combinations. Each class of drugs affects HIV in a different way:

• NRTIs (nucleoside and nucleotide reverse transcriptase inhibitors) interrupt the first step that HIV takes to “copy” itself inside a cell.

• NNRTIs (non-nucleoside reverse transcriptase inhibitors) also interrupt the first step that HIV takes to copy itself, but in a different way than NRTIs.

• Protease inhibitors interrupt the last step that HIV takes to copy itself.

• Entry inhibitors (including fusion inhibitors) stop HIV from entering a healthy cell.

New medicines in each of these drug classes are being developed. New drug classes, which attack HIV in new ways, are also being researched. Drugs that fight HIV have improved the health of many people, but these treatments are not perfect. HIV medicines can be hard to take and often have side effects, some ofwhich are serious and even life threatening. Missing or delaying just a few doses of medicine can lead to the person developing “resistance” to the drugs, which means that the drugs will stop working.

Opportunistic illnesses like PCP (Pneumocystis carinii pneumonia) and MAC (Mycobacterium avium complex) affect people whose immune systems are severely weakened by HIV. However, many of these illnesses can be prevented by taking certain medicines as soon as the immune system becomes weak. Since the immune system can be severely weakened before symptoms appear, it is important for people with HIV to see their doctors so that they can begin preventive treatment as soon as it is needed. A HAART regimen is the most effective way to strengthen the immune system.

Treatments for AIDS-related illnesses. Treatments for AIDS-related cancers, infections, and other conditions are available. Combining these treatments with HAART, as needed, can help people with AIDS live healthier, longer lives.

People with HIV should ask their doctor, nurse, or case manager for more information about these topics before they make any changes to their treatment plan.

Healthy living. Good health habits can play an important role in the treatment of HIV. Important factors include:

• eating healthy foods

• preparing and storing food safely

• taking vitamins as directed by a doctor or nutritionist

• exercise (both aerobic and muscle-building)

• getting enough sleep

• stress management

• avoiding alcohol, cigarettes, street drugs, and other harmful substances. Smoking increases the risk of bacterial pneumonia, thrush, and other oral health problems.