In light of yesterday’s news which reported that three people died after they stopped taking antiretroviral medicine on the advice of a religious leader, it’s important to highlight why anti-HIV drugs are significant and how essential it is to take them correctly.
HIV is a virus which attacks the immune system – the body’s defence system against infection and illness. If you have HIV, you can take drugs to reduce the level of HIV in your body. By reducing the amount of HIV in your body, you can slow or prevent damage to your immune system. These drugs are not a cure, but they can help you stay well and extend your life. Anti-HIV drugs are known as antiretroviral drugs.
HIV mainly infects cells in the immune system called CD4 cells. Over many years of HIV infection, the number of CD4 cells drops gradually but continually and the immune system is weakened. If nothing is done to slow or halt this destruction of the immune system, a condition called AIDS (Acquired Immune Deficiency Syndrome) follows, as the immune system is no longer able to fight infections. Antiretroviral drugs work by interrupting this process.
An untreated person with HIV may have thousands or even millions of HIV particles in every millilitre of blood. The aim of treatment is to reduce the amount of HIV to very low levels (this is called an ‘undetectable’ level) – below 50 copies per millilitre of blood, although some HIV treatment centres are now using tests that can measure as low as 40 copies/ml.
To provide you with the best chance of reducing the amount of HIV in your blood to very low levels, your doctor will recommend that you take a powerful combination of at least three antiretroviral drugs. Once your viral load – the amount of HIV in your blood – has dropped, your immune system should begin to recover and your ability to fight infections is likely to improve.
When you start or change a drug combination, a viral load and CD4 count will be done within the first month of treatment. This is to check that the drugs are working. Testing is generally performed every three months, although some doctors may perform tests more often to begin with and less frequently once you are well established on treatment and doing well.
Once you are on HIV treatment, you may have tests to measure liver and kidney function and fat and sugar levels in your blood, to assess the effects of the drugs on the normal workings of your body.
Your HIV care will also involve a number of other routine tests. These will be to monitor your general health and to see if your treatment is causing any side-effects.
It is very important not to miss doses of your anti-HIV drugs and to take them exactly as prescribed. If you miss doses, or you do not take the drugs as you are supposed to, the HIV in your body is more likely to develop resistance to them. This will reduce their long-term effectiveness.
The above information is taken from NAM’s “Anti-HIV Drugs” booklet which you can download from here, (or pick up a copy from LASS, next time you’re in) Additionally, Uptodate.com has very useful information and tips for taking HIV meds, it’s always a good idea to refresh your knowledge on Adherence.
Having a daily timetable for taking medication and taking all doses exactly as prescribed is the traditional definition of adherence, also known as compliance. This may sound simple, but in the case of highly active antiretroviral treatment (HAART), it is not. The challenge only increases as people who are infected and able to access therapy face life-long treatment and side-effect management.
If some medications are not taken at the correct time interval, the drug level can either be too high (causing unnecessary toxicities or side-effects) or too low (encouraging viral resistance). From a public health standpoint, suboptimal adherence also increases both the risk of transmission and the risk of transmitting drug-resistant virus to others.
Correctly taken, highly active antiretroviral therapy (HAART) maintains a consistent attack on HIV. When drug levels in the body fluctuate, HIV is given the opportunity to reproduce. Ongoing replication permits drug-resistant viral strains to develop and this narrows future treatment options.
Beyond personal benefit, maintaining adherence and viral suppression has a public health benefit. When viral load is low, so is the likelihood of transmission to others.
For more details on adherence or HIV medicines, speak with your doctor and health care professionals.
Philadelphia FIGHT (Field Initiating Group for HIV Trials) is a comprehensive AIDS service organization providing education, advocacy and research on potential treatments and vaccines. FIGHT was formed as a partnership of individuals living with HIV/AIDS and clinicians, who joined together to improve the lives of people living with HIV. They produce educational videos via “The AIDS Library” and serves the community through delivery of information on HIV, such as treatments, nutrition, and history of the pandemic, and referrals to regional and national resources.
The following videos are a 30 minute presentation on How HIV Meds work,
How HIV Meds Work Part 1: HIV Life Cycle
How HIV Meds Work Part 2: Drug Classes
How HIV Meds Work Part 3: Timing
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- Increase In Life Expectancy for People Living With HIV (lass.org.uk)
- No Hiding Place for HIV/AIDS (lass.org.uk)
- Blind Faith: HIV Prayer Cure Claims Three Deaths (lass.org.uk)
- Pill Box Organisers Increase HIV Patients’ Adherence & Improve Viral Suppression (lass.org.uk)