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Previously, HIV infection was considered incurable. However, there are more than 20 types of drugs that stop the reproduction of the virus, and new drugs are also at the development stage.
Modern combination therapy options (also: antiretroviral therapy = ART or highly active ART = HAART) allow the body to resist the virus, significantly prolonging the life of people with HIV and improving its quality. However, these drugs are not able to remove the virus from the body, that is, to completely cure. The drugs should be taken for life to prevent the development of life-threatening diseases.
Combination therapy drug classes
Like all viruses, HIV requires the presence of so-called host cells to reproduce. The latter include, for example, CD4 helper cells — cells of the immune system. First, the virus attaches to cells, then penetrates inside, introducing genetic information so that the cells themselves produce viral copies. Anti-HIV drugs are characterized by different points of application at these stages, which allows them to be classified into the following groups:
- Fusion inhibitors
- NRTIs (nucleoside or nucleotide reverse transcriptase inhibitors)
- NNRTIs (non-nucleoside reverse transcriptase inhibitors)
- PIs (protease inhibitors)
- The combination of different medications is crucial
If each of these medications can significantly slow down the multiplication of copies of HIV, why is a combination needed? It’s very simple: none of the drugs prescribed separately can completely and long-term prevent the reproduction of the virus. This is explained by the continuous emergence of new variants of the virus due to copying errors (mutations), among which viruses are also formed that are capable of reproducing even while taking the drug, changing the structure of the enzymes that block the action of the drugs.
If the patient is given only one drug (monotherapy), the number of copies will increase greatly after weeks, or even months, when the use of other drugs becomes ineffective, and most viruses will have an altered structure. In this case, the drug loses its effectiveness. This phenomenon is called viral drug resistance. This can be prevented by the simultaneous administration of several drugs: if the virus manages to evade the action of one drug. someone else comes to the rescue. As a rule, prescribing three medications helps prevent the development of resistance over the long term.
Ideally, drugs act in such a way as to completely suppress the formation of new viral copies — if new viruses are not formed, then there are no mutations either. The number of viral copies in the blood, that is, the viral load, decreases (the optimal result is the absence of HIV), and the number of helper cells increases: the immune system rests. To achieve this goal, strict adherence to the prescribed treatment is necessary. This allows you to live with HIV for a long time, but it is still not possible to accurately estimate life expectancy.
The key to achieving optimal effectiveness is, of course, drawing up a correct and individually tailored plan for each patient from the very beginning. The more experienced the doctor is in treating HIV, the more pronounced and lasting the positive effect of treatment will be. Therefore, treatment of persons with HIV/AIDS should be provided at all times in specialized HIV treatment practices or outpatient clinics.
Side effects
Side effects during treatment vary depending on the medication and the patient. Short-term side effects, such as diarrhea and headaches, disappear in most cases after a few weeks and usually respond well to treatment. With the help of modern drugs or by changing a combination of drugs, it is also possible to avoid long-term side effects, such as inflammation of the nerves of the extremities with severe pain (neuropathy) and disturbances in the metabolism and ratio of fats in the body (lipodystrophy), which also allow one to suspect HIV in the early stages. The total benefit of therapy significantly exceeds the side effects, as it allows not only to increase the life expectancy of HIV-infected individuals, but also to improve its quality.
HIV treatment and transmission
Stable and successful HIV treatment helps reduce the concentration of viral copies (viral load), which reflects the number of infected cells found in body fluids and mucous membranes, and thereby reduces the risk of infecting others. This is particularly emphasized in order to prevent transmission of the virus from mother to child.
In terms of preventing sexual transmission of HIV, antiretroviral therapy (ART) plays an important role in certain settings:
- the HIV viral load of the positive partner has been below the detection limit for at least the last 6 months;
- antiretroviral drugs are taken with strict adherence to the regimen;
- there are no defects in the mucous membranes, such as those caused by other sexually transmitted infections (STIs).
These conditions can be managed, usually within a couple, under close medical supervision. For people who are not in a stable relationship or who have sex outside of their relationship, the use of condoms is recommended to protect against HIV infection.
The cost of an HIV treatment program in Germany starts from 520 Euro. Includes:
- conversation between a leading doctor and a patient, taking an anamnesis
- general and biochemical blood test
- determination of immune status, viral load and other indicators directly related to determining the type of HIV infection and resistance
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