HIV Treatment: Keeping It Effective

The key to controlling HIV -and keeping your CD-4 count high and your viral load low-- is to stick PRECISELY to the daily schedule for your medication. If you miss doses or don't take them on a regular schedule, the virus could thrive and mutate so that one or more of the medications becomes ineffective. This is called DRUG RESISTANCE, and signs may include fatigue, nausea, and diarrhea. To keep tabs on how well your medications are working, you will get regular blood tests that measure your viral load and your CD-4 count. If the meds ARE working, the viral load may become very low or almost undetectable. And your CD4 count may be near normal. Another way to make sure your treatment remains effective is to be aware of any side effects that pop up unexpectedly or that are severe. They may signal that your multiple drug cocktail is no longer working, and it may be necessary to try another combination of drugs. Some side effects CAN be sudden AND serious, so it's important to see your doctor as soon as you notice them. Journaling even your minor side effects is a good idea too, so you can discuss at your next appointment. Another important way to protect the effectiveness of your treatment regimen is to make sure that ANY OTHER over-the-counter medications, supplements or drugs you're taking do NOT interfere with your antiretrovirals. Always discuss this with your doctor BEFORE you take anything. A healthy lifestyle, with physical activity, good nutrition, and stress management is also important for keeping your treatment working. For more information on living with HIV see the other videos in this series.

Hormonal birth control can prevent conception, help regulate your menstrual cycle, and ease some PMS symptoms. But if you're HIV positive, some types of anti-HIV medications can also reduce the effectiveness of your birth control pill. For instance, non-nucleoside reverse transcriptase inhibitors--or NRTIs--and protease inhibitors - which are standard components of combination treatments - CAN reduce or eliminate the effectiveness of oral contraceptives, whether it's a progestogen-only pill or a combination estrogen-progestogen pill. This is because the same set of enzymes in the liver that breakdown these anti-HIVdrugs, also quickly deactivates contraceptive pills. But on the other hand, oral contraceptives DO NOT impact THE ACTION OF THE antiretrovirals. So EVEN THOUGH your risk of pregnancy increases, your HIV treatment shouldn't be affected. However, other antiretroviral drugs, such as integrase inhibitors - also standard components of combination treatments -- DO NOT reduce the effectiveness of oral contraceptives.Bottom line: if you are using the birth control pill MAKE SURE you ask your doctor if your particular type of HIV treatment regimen raises your risk of pregnancy. And keep in mind, it's not just oral contraceptives that DON'T mix well with specific anti-HIV drugs; hormonal IUDs, vaginal rings, skin patches and shots MAY NOT be as effective, either. Regardless of the form of birth control you and your doctor decide upon, you should ALWAYS remember to use a condom to reduce chances of transmitting the virus to your partner or of you contracting a new strain of HIV that could make your medication regimen less effective. For more information on living with HIV, watch other videos in this series.

Ever hear the phrase "When one door closes, another one opens?" Starting HIV treatment is like opening yourself up to the possibility of a prolonged, healthy life. Treatment can make the amount of HIV in your blood-also called your viral load -- very low or even undetectable. It will also raise your CD4 count-indicating your immune system is rebounding. Opinions vary about how low your CD-4 count can fall before it's time to start taking antiretroviral medication; however, experts suggest that EARLY TREATMENT is the most effective in the long run.When you do start treatment, your doctor will likely prescribe a cocktail of 3 to 4 antiretroviral medications-called HAART or highly active antiretroviral therapy. Your overall health will impact the SPECIFIC cocktail you're prescribed, as will the existence of any pre-existing conditions, like hepatitis B or C. It's also the time to be HONEST with your doctor about personal issues you have, such as depression or substance abuse. Then you can work together to find solutions -- including ways to make medication affordable. Some initial side effects like nausea, vomiting and headaches CAN make it tough to stick to your treatment in the early days. But many of these side effects are temporary so STICK WITH IT, it will get better. But be sure to alert your doctor to any persistent or severe side effects.To make sure your treatment stays effective, it's CRITICAL that you follow your medication regimen PRECISELY. If you DO happen to miss a dose, take it as soon as you realize. But don't double up, if it's time for your next dose. If you've got questions about what to do, get in touch with your doctor before you take your next dose. For more information about your HIVtreatment, check out other videos in this series.

HIV is incurable and can lead to the potentially deadly disease AIDS. The GOOD news is that medications can slow the spread of HIV, and allow people who are infected to remain healthier for longer. To understand how medications work, it's helpful to understand the life cycle of HIV. This cyclical process begins when HIV enters the body and attaches to receptors on T-cells located in the immune system. One group of anti-HIV medications, entry inhibitors, stops this attaching process. An entry inhibitor binds either to the immune system's T-cells or to the invading HIV, thereby blocking the virus from bonding with healthy T-cells. Currently, the only FDA-approved entry inhibitor is marketed as Fuzeon, but others are being tested. Two other types of medication work to stop the second part of HIV's life cycle, reverse transcription. When HIV infects a cell, it copies its genetic code into that cell's DNA. As a result, the T-cell is "programmed" to create more copies of HIV. But because HIV is in the form of ribonucleic acid, or RNA, it must convert itself to the body's genetic make-up, which is deoxyribonucleic acid, or DNA, before it can infect the T-cells. This is what happens during reverse transcription. Nucleoside Reverse Transcriptase Inhibitors, or NRTIs, are one type of medication that stops this process, by interfering with the nucleotides, or building blocks, that convert RNA to DNA. In this manner, the new DNA cannot be built, and a cell cannot produce more HIV. The first HIV drug, "AZT," or Retrovir, is an NRTI medication. Other FDA-approved NRTIs include Emtriva, and Videx. Another type of medication which blocks RNA from converting to DNA is called Non-Nucleoside Reverse Transcriptase Inhibitors, or NNRTIs. While NNRTIs have the same mission as NRTIs, they accomplish it differently. HIV cannot transcribe its RNA to DNA without the aid of a transcriptase enzyme. NNRTI medications attach themselves to this enzyme and prevent the virus from converting. Four FDA-approved NNRTI medications can help stop this conversion process. A final anti-HIV treatment works to stop the last step of HIV infection, viral assembly. During viral assembly, a strand of DNA is cut up and put together to form new copies of HIV. This process requires the help of an enzyme called protease. A group of medications called protease inhibitors, or PIs, block the protease enzyme from cutting up the genetic material that will become HIV, thus stopping new cells of the virus from forming. There are ten PI medications on the market, including Aptivus, Kaletra, and Viracept. For antiretroviral treatment to be effective for a long time, multiple medications are usually taken. Most HIV patients are familiar with the term HAART, which stands for Highly Active Anti-Retroviral Therapy and it used to describe the combining of 3 or more HIV drugs. One drug, Atripla, which is known as the "triple cocktail" combines two NNRIs with one NNRTI. This medication is generally considered to be a once-a-day, all-inclusive HIV treatment. HIV treatment is an individualized process, so it's important to adhere to your doctor's instructions when taking medication to ensure that your body remains as healthy as it can for as long as possible!

AIDS is a disease that represents the final stages of infection with an incurable virus known as the human immunodeficiency virus, or HIV. To understand how AIDS works, it helps to have a grasp of HIV. Simply put, HIV attacks and destroys cells in the immune system, much as an invading army might destroy a high wall that protects a city. With a weakened immune system, a person becomes less able to fight off infections, as an army would have trouble defending a city without a protective wall. Before HIV can attack, it has to get in. HIV lives in bodily fluids like semen, vaginal secretions, blood, and breast milk. A person who carries HIV can pass it to another through any of these, usually via sexual intercourse, breastfeeding, or the sharing of drug paraphernalia. Rarely, a person will contract HIV through blood transfusions. And while it is highly unlikely for people to acquire HIV through saliva, it is possible to pass it through oral sex. Once the virus is transferred, it attaches to its new host body's sex, or T-cells, which are integral parts of the immune system. Inside the T-cell, HIV literally changes to become part of the body's DNA, or genetic code. At this point, the body will be forced to produce the virus. Because HIV lives in the immune system, every time a foreign invader triggers this system to work, HIV is activated, too. This means that when "good" T-cells fight, for example, the flu virus, new HIV particles are formed. During the first days and weeks after a person is infected with HIV, he or she may experience flu-like symptoms, such as a fever, fatigue, and enlarged lymph nodes. These symptoms generally disappear without treatment. But, as the body is forced to create new HIV cells, the immune system gets weaker, a progression that can take from several months to more than ten years. Eventually, untreated HIV leads to acquired immune deficiency syndrome, or AIDS. The name is appropriate: Acquired means to obtain an infection. Immune deficiency refers to weakness in the immune system, and syndrome is a group of problems that comprise a disease. AIDS is generally diagnosed by a blood or saliva test that measures the T-cells in a person's body. If the count drops below 200/mm3, the immune system is seriously damaged and unable to fight infections properly. A diagnosis of AIDS also occurs if a person gets one of 26 opportunistic infections, which are conditions common in advanced HIV patients, but rarely found in people with intact immune systems. Most people who die of AIDS do so from one of these infections. But while there is no cure for the disease, the introduction of highly active antiretroviral therapy has caused the number of AIDS-related deaths to decrease significantly. Over one million Americans are infected with HIV. Because 300, 000 people are still unaware of their HIV infection, getting tested and making sure you know your partner's status is essential.

Before a person becomes sick with the potentially deadly disease known as AIDS, he or she must first be infected with the human immunodeficiency virus, or HIV. This virus is spread through the sharing of blood, breast milk, semen, and vaginal secretions. While anyone can contract HIV, some people have a higher risk than others. These include, people who have unprotected vaginal, anal, or oral sex with multiple partners ...People who have injected sex with shared equipment, such as needlesPeople who have been diagnosed with another sexually transmitted disease, hepatitis, or tuberculosis... ...And anyone who has had sex with a partner who engaged in these acts. Men who have sex with men and people who have unprotected heterosexual contact make up 79 percent of new HIV cases, so these groups in particular should be tested regularly. When a person contracts HIV, his or her immune system starts to produce antibodies against the virus to ward off infection. Although these antibodies are not effective in fighting HIV, it is their presence in the blood that results in a positive HIV test. This test can be conducted at an STD clinic, a government funded HIV testing site, a hospital, or a doctor's office. The screen can be done in a number of ways, but the most common is a conventional blood test. In this case, a sample is drawn by a health care provider and sent to a lab for screening. A similar HIV test involves an oral fluid sample which is swabbed from the inside of the mouth before being tested. A slightly less accurate method involves a urine sample. In all three of these tests, results should arrive within two weeks, and a positive test must be followed up by a confirmatory one. This guards against the risk of a false positive. For individuals who are in need of very quick results, a rapid test is also available. In a rapid test, a blood or oral sample is collected and tested immediately in a lab. The results are available in as little as ten minutes. No matter the type of test, the procedure can be very scary, and for this reason, many testing centers provide counseling. If you'd rather not get tested in public, you have another option: home testing. It's important to know that only ONE home testing kit is approved by the FDA, the Home Access HIV-1 Test System. A home testing kit allows a person to prick his or her finger, place drops of blood on a special card, and mail the card into a lab. An HIV test can be scary, but a negative result will put your mind at ease. If your HIV test is positive, you have just taken an important first step on the road to treatment.

AIDS is an incurable disease that is the end result of infection by the human immunodeficiency virus, or HIV. An individual who contracts HIV may become sick quickly...or can live symptom-free for years. HIV and AIDS are not one-and-the same. Many people who become infected with HIV do not develop AIDs, or don't do so for decades...especially with modern treatments. AIDS, which is an acronym for "acquired immune deficiency syndrome," is the final stage of HIV infection. Because the virus attacks T-cells in the body's immune system, a person has AIDS when their T-cell levels fall below 200/mmc3, as opposed to the 500 to 1,500 found in a healthy person. An extremely low T-cell count means that a person's immune system is no longer healthy enough to effectively fight off intruding viruses and bacteria. Signs that HIV may be turning into AIDS include: extreme fatigue, rapid weight loss, persistent diarrhea, a high fever, and swollen glands in the neck, armpits, or groin. Even if a person doesn't have a low T-cell count, they are still classified as having AIDS if they contract any one of 26 opportunist conditions. These are a group of illnesses that don't generally occur in most people, but do show up in AIDS patients. Two of these are cancers. One, Kaposi's sarcoma, results from a tumor in the blood vessel walls. Kaposi's sarcoma usually appears as disfiguring pink or purple lesions on the skin and mouth. The other cancer, Non-Hodgkin's lymphoma, originates in the disease-fighting blood cells known as lymphocytes. This appears as swelling of the lymph nodes. Several opportunist conditions that confirm an AIDS diagnosis stem from invading bacteria, like tuberculosis and bacterial pneumonia. Bacterial pneumonia is a potentially deadly inflammation of the lungs that is one of the most common infections occurring in people with HIV worldwide. Tuberculosis is the leading opportunistic infection in developing nations where access to medications and health care is low. It occurs when bacteria infect the lungs and manifests as prolonged coughing fits. Sometimes, an opportunist infection can be fungal, like candidiasis. Candidiasis causes a white coating to form on the mouth, tongue, or vagina. Although HIV itself is a virus, another virus can enter the body and cause an opportunist infection. One example is cytomegalovirus, or CMV, a herpes virus that healthy adults fight easily. In people with HIV, however, the virus causes damages to the body, most notably the eyes. If untreated, CMV can lead to blindness. Other complications that lead to an AIDS diagnosis include wasting syndrome, whereby a person loses 10 percent or more of body weight, and AIDS dementia complex, where nerve cell damage causes diminished mental functioning. These conditions, and others, mean that HIV has progressed to AIDS. While this is disheartening, many modern medications can keep AIDS infections from progressing indefinitely. If you have HIV, talk to your doctor about diseases that can occur following infection and the best ways to treat them.

Of the 1.1 million Americans living with HIV and AIDS, most are men. But in the past 30 years the number of women affected has increased. In 2010 alone, there were a quarter of a million women in the US living with HIV. Most were infected through heterosexual sex or injection drug abuse.Women are particularly susceptible to HIV and STD infection because mucous membranes lining the vagina and cervix provide a large surface area for transmission. Other particularly female risk factors include menstruation and pregnancy, with its changing hormone levels and impact on the immune system. During menstruation, monthly fluctuations in estrogen and progesterone levels before each period, result in a cyclic thinning of vaginal and cervical tissue, which increases transmission risk. Estrogen and progesterone also affect how HIV reacts in the body. During the first 3 to 5 years of infection, those hormones cause women to have lower viral loads than men with the same, or similar, CD4 counts. Women also may experience different side effects from HIV medications than men, because of a generally lower body weight, a higher percentage of body fat, and different hormones. For example, the protease inhibitor ritonavir causes more nausea and vomiting in women, but less diarrhea than in men. Some studies indicate women are more susceptible to rashes, fat buildup, and problems with the pancreas and liver. Typically, women also have a tougher time sticking to their HIV medication regimen than men. The reasons here vary, but a large percentage of HIV positive women are single mothers and economically disadvantaged. These challenges, in addition to uncomfortable side effects, can make it hard to stick to a treatment plan. But when women DO adhere to their treatment, they can live as long as, and with as FEW complications, as men. For more information on living with HIV, check out other videos in this series.

You're HIV positive and pregnant. The best case is that BEFORE you conceived, you worked with your doctors to make sure your HIV is controlled and your medications are safe to use while pregnant. But if you're not on anti-HIV medications or have not planned for the pregnancy, you can still take steps to protect your fetus-and your own health. Make sure you're seeing an obstetrician experienced with HIV-positive pregnancies, in addition to an infectious disease specialist. Their first step is to get you on - or keep you on -- antiretroviral therapy. If you are just starting HIV treatment, some doctors will recommend you wait to start until week 12 of your pregnancy to protect against potential risks to the fetus. The good news is that taking anti-retrovirals, or ARVs, having a C-section, and bottle-not breast-- feeding, can cut the risk of transmission to your child by 98%. Without treatment, 15-30 percent of babies born to HIV-infected women become infected during pregnancy and delivery. Add another 20 percent if the babies are breastfed. During pregnancy, your viral load and CD4 count will be periodically evaluated. At 36 weeks, you and your obstetrician will decide on a mode of delivery. While a Cesarean is recommended to reduce the risk of HIV transmission during birth, vaginal delivery is possible for women with viral loads of 50 or less. If you are HIV positive and DO NOT get ARVs or prenatal care before delivery, taking ARVS during labor and delivery and having a C-section, can offer some protection to your fetus. Immediately after birth, no matter the delivery method or your treatment status, your baby will be put on anti-retroviral medicine from four to six weeks. For more information on living with HIV, check out other videos in this series.

If you've recently tested positive for HIV, you'll want to learn about the disease and how to best manage it. So start by asking your doctor these questions. How much experience do you have with HIV positive patients? If your doctor doesn't have much experience, ask him or her for a referral to a physician who does. Once you have an HIV specialist, ask: What are my treatment options? And when should I start? Depending on the stage at which you're diagnosed and any pre-existing conditions you may have, the start time and medication regimen may vary. So make sure to tell your doctor your complete medical history. What are the side effects from the medications? Side effects from HIV treatment are common, but they're different for everyone, and usually ease over time. Keep your doctor posted about what you're experiencing. What kind of regular tests do I need to get? You'll get regular blood tests to measure your immune strength -or CD4 count--and the strength of the HIV virus -or viral load-- especially when starting treatment. These tests let you know if treatment is working. How do I keep from spreading the virus? You can't spread HIV through casual contact, but you shouldn't share toothbrushes, razors or anything else that may contain bodily fluids or blood. Your doctor can explain the risks associated with oral, anal and vaginal intercourse, suggest effective methods of protection, and fill you in on the effect of anti-HIV drugs on hormonal birth control. In addition, you may want to ask about getting financial aid to pay for your medications and information on support groups. For more detailed answers to these and other questions, check out the videos in this series.