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Treatment

DRUGS FOR HIV INFECTION

Currently, there are 26 antiretroviral drugs approved by the Food and Drug Administration to treat individuals infected with HIV. These drugs fall into three major classes.

Reverse transcriptase (RT) inhibitors interfere with the critical step during the HIV life cycle known as reverse transcription. During this step, reverse transcriptase, an HIV enzyme, converts HIV RNA to HIV DNA. There are two main types of RT inhibitors.
- Nucleoside/nucleotide RT inhibitors are faulty DNA building blocks. When these faulty pieces are incorporated into the HIV DNA (during the process when the HIV RNA is converted to HIV DNA), the DNA chain cannot be completed, thereby blocking HIV from replicating in a cell.
- Non-nucleoside RT inhibitors bind to reverse transcriptase, interfering with its ability to convert the HIV RNA into HIV DNA.
Protease inhibitors (PI) interfere with the protease enzyme that HIV uses to produce infectious viral particles.
Fusion inhibitors interfere with the virus’ ability to fuse with the cellular membrane, thereby blocking entry into the host cell.

Drugs Approved for HIV Infection

Nucleoside/Nucleotide RT Inhibitors	Non-nucleoside RT Inhibitors	Protease Inhibitors	Fusion Inhibitors
Retrovir (zidovudine, AZT)*	Viramune (Nevirapine)*	Invirase (saquinavir-HGC)	Fuzeon (enfuvirtide)*
Videx (didanosine, ddI)*	Rescriptor (delavirdine)	Norvir (ritonavir)*
Hivid (zalcitabine, ddC)	Sustiva (efavirenz)*	Crixivan (indinavir)
Zerit (stavudine, d4T)*		Viracept (nelfinavir)*
Epivir (lamivudine, 3TC)*		Fortovase (saquinavir-SGC)
Combivir (AZT and 3TC)		Agenerase (amprenavir)*
Ziagen (abacavir)*		Kaletra (lopinavir and ritonavir)*
Trizivir (AZT + 3TC + abacavir)		Lexiva (fosamprenavir)
Viread (tenofovir)		Aptivus (tipranavir)
Emtriva (emtricitabine)		Reyataz (atazanavir)
Epzicom (abacavir/ lamivudine)
Truvada (tenofovir/emtricitabine)

* Pediatric approval

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) COUNTERS DRUG RESISTANCE

As HIV reproduces itself, different strains of the virus emerge, some that are resistant to antiretroviral drugs. Therefore, doctors recommend patients infected with HIV take a combination of antiretroviral drugs known as HAART. This strategy, which typically combines drugs from at least two different classes of antiretroviral drugs, has been shown to effectively suppress the virus when used properly. Developed by NIAID-supported researchers, HAART has revolutionalized how we treat people infected with HIV by successfully suppressing the virus and decreasing the rate of opportunistic infections.

ANTIRETROVIRAL DRUG EFFECTS ON OPPORTUNISTIC INFECTIONS AND AIDS-ASSOCIATED CO-INFECTIONS

People infected with HIV have impaired immune systems that can leave them susceptible to opportunistic infections (OIs) and AIDS-associated co-infections, caused by a wide range of microorganisms such as protozoa, viruses, fungi, and bacteria. One example is hepatitis C virus (HCV) infection which can lead to liver cancer.

Potent HIV therapies such as HAART, however, have produced dramatic responses in patients by suppressing HIV and slowing the progression of OIs and AIDS-associated co-infections. These therapies allow the immune system to recover, sustain, and protect the body from other infections. Hence, antiretroviral drugs provide a way for the immune system to remain intact and effective, thereby improve the quality and duration of life for people with HIV.

SIDE EFFECTS AS BARRIERS TO ANTIRETROVIRAL DRUG USE

People taking antiretroviral drugs often have low adherence to complicated drug regimens. The current recommended regimen involves taking several antiretroviral drugs each day from at least two different classes, some of which may require fasting and cause unpleasant side effects such as nausea and vomiting. In addition, antiretroviral drugs may cause more serious medical problems, including metabolic changes such as abnormal fat distribution, abnormal lipid and glucose metabolism, and bone loss. Therefore, NIAID is investigating simpler, less toxic, and more effective drug regimens

This section was found on http://www.niaid.nih.gov/factsheets/treat-hiv.htm

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Prevention of AIDS and HIV Infection

The only way to protect from contracting AIDS sexually is to abstain from sex outside of a mutually faithful relationship with a partner whom the person knows is not infected with the AIDS virus. Otherwise, risks can be minimized if they:

Don't have sexual contact with anyone who has symptoms of AIDS or who is a member of a high risk group for AIDS.
Avoid sexual contact with anyone who has had sex with people at risk of getting AIDS.
Don't have sex with prostitutes.
Avoid having sex with anyone who has multiple and/or anonymous sexual partners.
Avoid oral, genital and anal contact with partner's blood, semen, vaginal secretions, feces or urine. Unless they know with absolute certainty that their partner is not infected, a latex condom should be used during each sexual act, from start to finish. The use of a spermicidal agent may provide additional protection.
Avoid anal intercourse altogether.
Don't share toothbrushes, razors or other implements that could become contaminated with the blood of anyone who is or might be infected with the AIDS virus.
Exercise caution regarding procedures, such as acupuncture, tattooing, ear piercing, etc., in which needles or other nonsterile instruments may be used repeatedly to pierce the skin and/or mucous membranes.

Such procedures are safe if proper sterilization methods are employed or disposable needles are used. Ask what precautions are taken before undergoing such procedures.
If an individual is scheduling surgery in the near future, and is able, they could consider donating blood for their own use. This will eliminate completely the already small risk of contracting AIDS through a blood transfusion. It will also eliminate the more substantial risk of contracting other bloodborne diseases (such as hepatitis) from a transfusion.

If a person is an IV drug user, adhere to the prevention tips mentioned earlier, as well as:

Get professional help for terminating the drug habit.
Do not share needles or syringes. Be aware that some street sellers are resealing previously used needles and selling them as new.
Clean the needle before using.

Some people apparently remain well after infection of the AIDS virus. They may have no physically apparent symptoms of illness. However, if proper precautions are not used with sexual contacts and/or intravenous drug use, these infected individuals can spread the virus to others.

Anyone who thinks he or she is infected, or who is involved in high-risk behaviors, should not donate his/her blood, organs, tissues, or sperm as they may now contain the AIDS virus.

This section was found at http://www.healthscout.com/ency/68/101/main.html#PreventionofAIDSandHIVInfection

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Symptoms of AIDS and HIV Infection

Some people infected with HIV are asymptomatic (no symptoms) while others may develop symptoms of HIV from two to 15 years after initial infection. The symptoms are as follows:

extreme fatigue
rapid weight loss from an unknown cause (more than 10 lbs. in two months for no reason)
appearance of swollen or tender glands in the neck, armpits or groin, for no apparent reason, lasting for more than four weeks
unexplained shortness of breath, frequently accompanied by a dry cough, not due to allergies or smoking
persistent diarrhea
intermittent high fever or soaking night sweats of unknown origin
a marked change in an illness pattern, either in frequency, severity, or length of sickness
appearance of one or more purple spots on the surface of the skin, inside the mouth, anus or nasal passages
whitish coating on the tongue, throat or vagina
forgetfulness, confusion and other signs of mental deterioration

It can take as short as a year to as long as 10 to 15 years to go from being infected with HIV to "full-blown" AIDS.

According to the Center for Disease Control and Prevention, a person is considered to have AIDS when they have a T cell count (also called CD4 cell count) of 200 or less (healthy T cell levels range from 500 to 1500) or they have an AIDS-defining condition. The AIDS-defining conditions are:

· Candidiasis

· Cervical cancer (invasive)

· Coccidioidomycosis, Cryptococcosis, Cryptosporidiosis

· Cytomegalovirus disease

· Encephalopathy (HIV-related)

· Herpes simplex (severe infection)

· Histoplasmosis

· Isosporiasis

· Kaposi's sarcoma

· Lymphoma (certain types)

· Mycobacterium avium complex

· Pneumocystis carinii pneumonia

· Pneumonia (recurrent)

· Progressive multifocal leukoencephalopathy

· Salmonella septicemia (recurrent)

· Toxoplasmosis of the brain

· Tuberculosis

· Wasting syndrome

People who are not infected with HIV may also develop these diseases; this does not mean they have AIDS. To be diagnosed with AIDS, a person must be infected with HIV.

Some people infected with HIV may develop a disease that is less serious than AIDS, referred to as AIDS Related Complex (ARC). ARC is a condition caused by the AIDS virus in which the patient tests positive for AIDS infection and has a specific set of clinical symptoms. However, ARC patients' symptoms are often less severe than those with classic AIDS.

Signs and symptoms of ARC may include loss of appetite, weight loss, fever, night sweats, skin rashes, diarrhea, tiredness, lack of resistance to infection or swollen lymph nodes.

Note: Not everyone who has been infected with HIV develops AIDS. However, these people may develop some of the symptoms related to AIDS.

This section was found at http://www.healthscout.com/ency/68/101/main.html#SymptomsofAIDSandHIVInfection

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Definition of AIDS and HIV Infection

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a serious condition that weakens the body's immune system, leaving it unable to fight off illness.

AIDS is the last stage in a progression of diseases resulting from a viral infection known as the Human Immunodeficiency Virus (HIV or AIDS virus). The diseases include a number of unusual and severe infections, cancers and debilitating illnesses, resulting in severe weight loss or wasting away, and diseases affecting the brain and central nervous system.

Presently, there is no cure for HIV infection or AIDS, nor is there a vaccine to prevent HIV infection. However, there are new medications which help slow the progression of the infection and reduce the seriousness of HIV consequences in many people.

This section was found at http://www.healthscout.com/ency/68/101/main.html#DefinitionofAIDSandHIVInfection