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HIV treatment is managed by specialist outpatient clinics, staffed by doctors, nurses and other health professionals. Patients are usually seen every few months, when the status of their immune system and their general health is reviewed.

Once the number of CD4 cells has fallen to a low level, or if the amount of virus in the blood is very high, the specialist may recommend starting drug treatment. All treatment decisions are made jointly with the specialist.

Current treatments prevent the virus from replicating in the body. This in turn reduces the amount of virus in the blood and allows the immune system to recover. To achieve this, two or more "antiretroviral" drugs must be taken. They normally have to be taken between one and three times a day and at specific times. This combination therapy is termed highly-active antiretroviral therapy (HAART) and has dramatically cut the number of deaths from AIDS since its introduction in 1996. There are three main classes of antiretroviral drug. Combination therapies usually contain drugs from two of these classes.

Nucleoside reverse transcriptase inhibitors (NRTIs) prevent HIV from copying its genetic information and so multiplying. They include AZT (Retrovir), which was the first ever anti-HIV drug. When first used on its own, AZT had serious side-effects. Now it is used in much lower doses in combination with other drugs.

Protease inhibitors (PIs) prevent the virus from assembling its protective coat before leaving CD4 cells. They include saquinavir (Invirase; Fortovase) and ritonavir (Norvir).

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are a newer, highly effective class of drug, which have a similar mode of action to NRTIs. They include efavirenz (Sustiva) and nevirapine (Viramune).

A new class of antiretroviral drug, known as an HIV fusion-inhibitor has recently been launched and will initially be used for people whose disease is no longer controlled by other treatments. At present there is just one fusion- inhibitor, enfuvirtide (Fuzion).



Side-effects

Despite the benefits of these new drug combinations, they often cause side-effects. In the first few months of treatment, people may experience nausea, vomiting and headaches, although these often wear off. Some drugs can cause sleep disturbances or depression. Protease inhibitors have been associated with a syndrome called lipodystrophy, which involves a thinning of the face, arms and legs, and a build-up of fat in the belly and on the back. Treatments for these side-effects are being developed.

In the future, further classes of anti-HIV drug may be produced. These may include drugs that stimulate the patient's own immune system to fight off HIV. There are also real hopes that a cure for HIV infection and a vaccine to prevent infection will be developed.