HIV Treatment

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The first step in treating HIV disease is getting a correct diagnosis. A simple blood test to detect HIV antibodies, known as the ELISA test, can be done at a testing site, a doctor's office, or a clinic. If the initial result is retested to verify the result. If the result of that test, too, is positive, a more sophisticated test, the Western blot test, is done to confirm the findings of the ELISA.

Experts recommend that anyone in a group considered to be at high risk of HIV infection be tested for the disease so that treatment, if necessary, can be begun promptly. Those at high risk include males who have had unprotected sex with other males; individuals who have shared needles or syringes to inject drugs or steroids; anyone who has had unprotected sex with multiple partners within the last ten years; anyone who has had any sexually transmitted disease within the last ten years; anyone who received a blood transfusion or blood-clotting factor between 1978 and 1985; and anyone who has had unprotected sex with anyone who might fit the categories outlined above. They also recommend testing for women who are, or who plan to become, pregnant.

If you are diagnosed with HIV, it is important to find and work closely with a physician who specializes, or at the very least has considerable experience, in treating this condition. Treatment of HIV disease is extremely complicated, and new information and treatment approches surface virtually on a daily basis. Working with a practitioner you can count on to know the latests developments and findings is vital. Studies suggest that the length of survival and the quantity of life for a person with HIV disease may be related more to the expertise of his or her physician than to any other factor. It is also important to find a doctor with whom you feel comfortable, since yours will be a long-term relationship.

If you are found to be HIV-positive, your CD4 count should be monitored at least every six months. Antiviral treatment is usually started when the count falls below 500 o when symptoms begin.

Treatment of HIV infection itself is aimed at inhibiting the virus and keeping it from reproducing. There is a long list of drugs that are used for this purpose. Delavirdine (Rescriptor), didanosine (Videx, known colloquially as ddI), lamivudine (Epivir, or 3TC), nevirapine (Viramune, or NVP), stavudine (Zert, or d4T), zalcitabine (Hivid, or ddC), and zidovudine (Retrovir, still generally refered to by its former name, azidothymidine, or AZT) do this by inhibiting the action of the enzyme reverse transcriptase, which plays a necessary role in the reproduction of the virus. Indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Invirase) are drugs that block the action of another viral enzyme, protease. One problem with all of the drugs used to supress HIV is that the virus has the ability to develop resistance to them, often within a relatively short period of time. For this reason, combination therapy using two or three different drugs at once has become the preffered approch. It may be necessary to experiment with different drug combinations to find the regimen that works best for you. All of the agents used against HIV can cause significant side effects, ranging from nausea, headaches, mouth ulcers, and skin rashes to disorders of fat metabolism to blood abnormalities, liver damage, and pancretitis. Though they can be unpleasent, side effects must be weighed against the seriousness of the condition yu are trying to fight.

Another genaral approach to treating HIV involves efforts to "jump-start" the hematopoietic (blood-building) system, boosting the production of red or white blood cells to compensate for those destroyed by the virus. The drugs used for this purpose are expensive, and include epoetin alfa (Epogen, Procrit), filgrastim (Neupogen, or G-CSF), and sargramostim (Leukine, or GM-CSF). These therapies are genarally reserved for the later stages of the disease.

Specific infections and complications should be treated promptly and aggressively, as they occur:

Pneumocystis carinii, the most common opportunistic infection, is treated with powerful combination antibiotics, such as trimethoprim plus sulfamethoxazole. Unfortunately, many people have allergic reactions to the sulfa component of this drug. If you cannot tolerate TMP/SMX, or if it proves ineffective, other drugs may be tried, including dapsone and pentamidine. Potential side effects of dapsone include blood problems, muscle weakness, nausea, vomiting, abdominal pain, dizziness, and serious skin reactions. Pentamidine must be used with caution, as it can cause severely low blood pressure, low blood sugar, and heart and pancreatic problems. In addition to antibiotics, steroids may be prescribed for a brief period to decrease inflammation. Aggressive oxygen and respiratory therapy may be needed in severe cases. Pneumocystis pneumonia also carries a risk of pneumothorax, in which air gets trapped outside the lung but inside the chest cavity. This can become an ongoing problem. The evacuation tube inserted surgically through the chest wall to treat the situation tends to heal poorly, sometimes requiring the application of an irritant such as talc or bleomycin to induce the opening to scar itself closed. Otherwise, the area may have to be stapled closed or further surgical intervention may be required.
Viral infections such as CMV may be treated with antiviral medication such as foscarnet or ganciclovir. These drugs are potentially quite toxic, and may only slow the progression of a viral disease rather than curing it altogether.
For fungal infections, such as oral thrush or yeast vaginitis, a doctor may prescribe an oral antifungal agent such as fluconazole or itraconazole.
Parasitic infections, such as giardiasis and cryptosporidiosis, along with viral, bacterial, and amoebic infection, are all potential causes of enterocolotis, a common problem. This is an inflammation of the colon that results in potentially serious diarrhea, along with high fever and abdominal pain. This problem can affect anyone, whether HIV-positive or not, but it tends to be both more severe and more chronic in people with HIV. Treatment starts with stool cultures and microscopic examination to track down the offending organism. This is of paramount importance, as different organisms, unfortunately, such as cryptosporidia, there is still no universally effective treatment, and so a variety of different drugs may be tried. Both bacterial and parasitic infections are treated aggressively with antibiotics, possibly administrated intravenously. Whenever you must take antibiotics, be sure to take then for the full course prescribed by your physician.
Nausea, a common problem for people with HIV disease, is often a result of a yeast outbreak in the throat, so it is often treated with an oral antifungal medication. If that fails, an antiemetic such as prochlorperazine (Compazine) or metoclopramide (Reglan) may be prescribed. These drugs can cause drowsiness, restlessness, unusual involuntary movements, and other side effects, but it is important to treat nausea t keep weight loss at a minimum.
Loss of appetite and resulting weight loss are real dangers for people with AIDS. Besides nutritional counseling and the use of high-calorie dietary supplements, a variety of drugs may be used for this, including megestrol (Megace), a synthetic derivative of the hormone progesterone that stimulates the appetite; dronabinol (Marinol), a compound extracted from marijuana that both stimulates the appetite and combats nausea; and growth hormone (Genotropin). All of these treatments have downsides, unfortunately. Megestrol can cause blood clots, heart failure, mood changes, and increases in blood sugar and blood pressure. Marinol can cause drowsiness, behavioral changes, altered gait, and anxiety. It also has significant abuse potential. Growth hormone is expensive, costing over $150.00 a day, and can cause muscle aches, swelling, and other side effects. Anabolic steroids, administered by injection or skin patch, may be used to combat weight loss as well, but they are normally reserved for those who are willing and able to do weight training. Possible side effects include stroke, breast tenderness and/or enlargement, urinary tract infections, prostate inflammation, and others.
Fever is a common problem. If no underlying infection can be found, standard antipyretics (fever-reducing drugs) are used. Ibuprofen (Advil, Motrin, Nuprin, and others) and naproxen (Aleve, Anaprox, Naprelan, Naprosyn) are considered more effective than either aspirin or acetaminophen (Tylenol) for this purpose.
There is little that can be done for unexplained sweats, which are also common in people with AIDS, even in the absence of fever. This symptom usually causes renewed examination for hidden infections, however.
Diarrhea is usually treated with standard therapies, but more aggressively than in healthy individuals because the complications of weight loss make it a more serious symptom for people with HIV disease.
If you have a history of opportunistic bacterial or yeast infection, a lower dose, longer term regimen of antibiotics may be prescribed as a preventive. A physician must closely monitor this kind of treatment.
Blood transfusions are not uncommon in advanced cases to increase the presence of infection-fighting white blood cells. Epoetin alfa, a very expensive drug, may be used in an attempt to lessen the number of transfusions required.

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