Treatment
Medications
Today, there are more than 25 different HIV medications that suppress HIV replication, and new substances are being developed and tested. The active ingredients block different phases of the HIV replication cycle. In antiretroviral therapy (ART, also known as highly active ART = HAART), several of these substances are combined to increase the effectiveness of the treatment and prevent resistance development (which is why it is also called combination therapy).
Since effective ART suppresses viral replication to very low levels, the progression of the disease is stopped, allowing the immune system to recover and preventing the occurrence of symptoms and the development of AIDS. Symptoms that are already present can regress.
Although ART cannot reverse the damage HIV already causes to the immune system in the first few days and weeks, successful therapy offers a good chance of a normal life expectancy and good quality of life.
Since the medications cannot remove HIV from the body, they probably need to be taken for life.
It is important that the therapy works well right away: The faster the viral load in the blood falls below the detection limit, the more likely will the specific combination be permanently effective. Therefore, HIV patients should be treated at medical practices, or outpatient clinics specialising in HIV from the very beginning.
When selecting the combination of substances, various aspects are taken into account, such as:
- Are any HIV strains present that are insensitive (resistant) to one or more HIV medications? In Germany, this is currently the case with about ten percent of all newly diagnosed HIV infections. This can be determined by resistance testing.
- What treatment regimen can be best integrated into the daily routine? Some medications need to be taken with food, others on an empty stomach, most of them once a day, others twice a day, and some even only once every few weeks.
- How do side effects such as diarrhoea or dizziness affect the patient’s professional, private, and sex life?
- Are there any other medical conditions? Some HIV medications are not “compatible” with other substances or need to be precisely adapted to them.
Side effects
When starting ART, side effects such as diarrhoea or nausea, fatigue, headache and muscle pain or skin rash occur frequently, but usually disappear again after a few weeks. In rare cases, there are problematic undesirable effects, such as severe allergic reactions, acute live inflammation, or hypersensitivity reactions, necessitating a change in the substance combination. This is also important to ensure the high level of “compliance” that is required for the long-term effectiveness of the therapy.
Long-term side effects mainly affect kidney function, metabolism, the nerves in the arms and legs as well as liver function.
Start of therapy
Today, the guidelines recommend starting HIV therapy as soon as possible after the diagnosis. However, if severe AIDSdefining conditions are already present, these are often treated first and ART is started a little later. In any case, comprehensive medical consultation is recommended. Contact details of HIV specialists can be found at the local AIDS Service Organisations or at www.dagnae.de/aerzte.
Adherence
To ensure that the antiretroviral substances are permanently present in the blood in sufficient concentration and to prevent resistance development, the HIV medications must be taken regularly and as prescribed. Interactions with other substances (e.g. medications or drugs) also need to be taken into account: They may reduce or increase the concentration of the HIV medications or the other substances in the blood.