Exploring HIV Treatment Options
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Within a generation, highly effective treatments have transformed the human immunodeficiency virus (HIV) from a death sentence to a chronic disease that can often be managed by taking a single pill a day.
Although there’s no cure for HIV or AIDS (acquired immunodeficiency syndrome), today’s antiretroviral drugs can suppress the virus to undetectable levels in the body and cause far fewer side effects than earlier treatments. What’s more, the right HIV treatment can make living with HIV easier and decrease the risk of transmission of the virus to others.
How HIV Treatment Has Changed
When the HIV/AIDS epidemic began in the 1980s, people with HIV were often given only a few years to live. Today, there are 31 antiretroviral medications approved to treat HIV, and with prompt diagnosis and proper treatment, people with HIV can expect to live nearly as long as people without the virus.
“What’s changed in the last 5 to 10 years is the increased attention on developing drugs that are more convenient with fewer side effects,” says Paul Volberding, MD, a professor in the department of medicine at the University of California in San Francisco and the director of the university’s AIDS research institute. “The single-pill regimen has transformed HIV treatment.”
In the past, people with HIV had to take a handful of pills every day to treat their condition, plus manage the side effects caused by the potent drugs. Now, many therapies are being combined into a single pill.
“The newer HIV medication options have limited side effects, which allows people to take their medications for a long time while really being able to get on with their lives,” says Dr. Volberding.
The other main development in HIV treatment, he says, is new research that suggests current therapies not only suppress the virus but can also prevent its transmission to others.
HIV Treatment Options
Current HIV treatment guidelines from the National Institutes of Health recommend antiretroviral drugs for everyone with the HIV infection, regardless of CD4 count, the indicator of immune function in people with HIV.
Until 2012, treatment was considered optional for people with HIV with normal CD4 counts who were at lower risk of disease progression. The new guideline is designed to reduce the risk of progression to AIDS as well as prevent the spread of the disease.
“We no longer wait to start treatment,” says Volberding. “There’s benefit to the people with HIV themselves as well as to the general public by way of stopping transmission of the virus.”
Most HIV treatment regimens consist of three different drugs, which often can be combined into a single daily pill. Combination antiretroviral therapy attacks the HIV virus at different points of its life cycle. These drugs create a synergistic effect in suppressing the virus that’s greater than the sum of its parts, says Volberding.
The main types of antiretroviral medications used to treat HIV treatment include:
- Nucleoside reverse transcriptase inhibitors (NRTIs), which block one of the enzymes that HIV needs to replicate itself in a cell.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs), which target the same enzyme as NRTIs, but with a different chemical structure.
- Protease inhibitors (PIs), which stop the production of one component of HIV.
- Entry inhibitors, which block the entry of HIV into CD4 cells.
- Integrase inhibitors, which block HIV from inserting its viral DNA into host cells.
Choosing HIV Treatment That’s Right for You
Discussing the benefits and risks of different HIV treatment options with your doctor can help you choose treatment that’s right for you based on your individual health status and lifestyle. “The choice is based on what’s effective and convenient,” says Volberding. Factors that can come into play include your stress level, eating habits, and any other medications you’re taking. Your doctor should also check for HIV drug resistance with a blood test.
Once you’ve been prescribed HIV treatment, it’s vital to stick with your antiretroviral therapy to get the best results. “Whatever the prescription says, do it every single day,” says Volberding. “The drugs work when taken.
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