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Sunday, July 13, 2008

Treatment

What is HIV antiretroviral treatment?

This is the main type of treatment for HIV or AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of someone's life. To understand more about treatment you need to have some basic knowledge of HIV and AIDS.

Antiretroviral treatment for HIV infection consists of drugs which work against HIV infection itself by slowing down the replication of HIV in the body. The drugs are often referred to as:

* antiretrovirals
* anti-HIV drugs
* HIV antiviral drugs

What is Combination Therapy, what is HAART?

For antiretroviral treatment to be effective for a long time, it has been found that you need to take more than one antiretroviral drug at a time. This is what is known as Combination Therapy. The term Highly Active Antiretroviral Therapy (HAART) is used to describe a combination of three or more anti-HIV drugs.

When HIV replicates (makes new copies of itself) it often makes mistakes. This means that within any infected person there are many different strains of virus. Occasionally, a new strain is produced that happens to be resistant to the effects of an antiretroviral drug. If the person is not taking any other type of drug then the resistant strain is able to replicate quickly and the benefits of treatment are lost.

Taking two or more antiretrovirals at the same time vastly reduces the rate at which resistance develops.
The groups of antiretroviral drugs

There are five groups of anti-HIV drugs. Each of these groups attacks HIV in a different way.
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
Medication

The first group of antiretroviral drugs are the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs). These were the first type of drug available to treat HIV infection in 1987. NRTIs (also known as nucleoside analogues or nukes) interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself. NRTIs are sometimes called the "backbone" of combination therapy because most regimens contain at least two of these drugs.
Non-Nucleoside Reverse Transcriptase Inhibitors

The second group of antiretroviral drugs are the Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), which started to be approved in 1997. Like the nukes, NNRTIs (also known as non-nucleosides or non-nukes) stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.
Protease Inhibitors
Medication

The third type of antiretrovirals is the protease inhibitor (PI) group. The first protease inhibitor was approved in 1995. Protease inhibitors, as the name says, inhibit protease, which is another protein involved in the HIV replication process.
Fusion or Entry Inhibitors

The fourth group of antiretrovirals is comprised of entry inhibitors, including fusion inhibitors. Entry inhibitors prevent HIV from entering human immune cells.

One fusion inhibitor - commonly called T-20 - has been licensed both in the US and in Europe since 2003, but only for use by people who have already tried other treatments. T-20 differs from the other antiretrovirals in that it needs to be injected (otherwise it would be digested in the stomach).

A new type of entry inhibitor known as maraviroc was licensed in 2007. This drug is known as a CCR5 inhibitor as it blocks the CCR5 co-receptor on human immune cells, preventing HIV from attaching to the cells' surface.
Integrase Inhibitors

The final group of antiretrovirals currently consists of just one drug, raltegravir, which was approved in the US in October 2007 and was introduced in the UK in January 2008. Raltegravir inhibits an enzyme called integrase, which HIV needs to insert its genetic material into human cells.
What does a combination usually consist of?

Highly Active Antiretroviral Therapy consists of a combination of three or more drugs. The most common combination given to those beginning treatment consists of two NRTIs combined with either an NNRTI or a "boosted" protease inhibitor. Ritonavir (in small doses) is the drug most commonly used to boost a protease inhibitor. An example of a common combination is the two NRTIs zidovudine and lamivudine combined with the NNRTI efavirenz.

See our drugs table for a comprehensive list of available antiretroviral drugs.
What if HAART is unavailable?

Although coverage has improved greatly in recent years, most people living with HIV in the developing world still have no access to antiretroviral treatment. Instead, the best they can hope to receive is treatment for the diseases that occur as a result of a weakened immune system, which are known as opportunistic infections. Such treatment has only short-term benefit because it does not address the underlying immune deficiency itself.

Is there a cure for AIDS?

Is there a cure for AIDS?
HIV medication can slow the progress of the virus

HIV medication can slow the

progress of the virus

Worryingly, surveys show that many people think that there's a 'cure' for AIDS - which makes them feel safer, and perhaps take risks that they otherwise shouldn't. These people are wrong, though - there is still no cure for AIDS.

There is antiretroviral medication which slows the progression from HIV to AIDS, and which can keep some people healthy for many years. In some cases, the antiretroviral medication seems to stop working after a number of years, but in other cases people can recover from AIDS and live with HIV for a very long time. But they have to take powerful medication every day of their lives, sometimes with very unpleasant side effects.

There is still no way to cure AIDS, and at the moment the only way to remain safe is not to become infected.

Can anything 'create' HIV?

Can anything 'create' HIV?

No. Unprotected sex, for example, is only risky if one partner is infected with the virus. If your partner is not carrying HIV, then no type of sex or sexual activity between you is going to cause you to become infected - you can't 'create' HIV by having unprotected anal sex, for example.

You also can't become infected through masturbation. In fact nothing you do on your own is going to give you HIV - it can only be transmitted from another person who already has the virus.

Is kissing risky?

Is kissing risky?

Kissing someone on the cheek, also known as social kissing, does not pose any risk of HIV transmission.

Deep or open-mouthed kissing is considered a very low risk activity for transmission of HIV. This is because HIV is present in saliva but only in very minute quantities, insufficient to lead to HIV infection alone.

There has only been one documented instance of HIV infection as a result of kissing out of all the millions of cases recorded. This was as a result of infected blood getting into the mouth of the other person during open-mouthed kissing, and in this instance both partners had seriously bleeding gums.

What is 'safer sex'?

What is 'safer sex'?

Safer sex is used to refer to a range of sexual activities that hold little risk of HIV infection.

Safer sex is often taken to mean using a condom for sexual intercourse. Using a condom makes it very hard for the virus to pass between people when they are having sexual intercourse. A condom, when used properly, acts as a physical barrier that prevents infected fluid getting into the other person's body.

What does 'safe sex' mean?

What does 'safe sex' mean?

Safe sex refers to sexual activities which do not involve any blood or sexual fluid from one person getting into another person's body. If two people are having safe sex then, even if one person is infected, there is no possibility of the other person becoming infected. Examples of safe sex are cuddling, mutual masturbation, 'dry' (or 'clothed') sex . . .

In many parts of the world, particularly the USA, people are taught that the best form of safe sex is no sex - also called 'sexual abstinence'. Abstinence isn't a form of sex at all - it involves avoiding all sexual activity. Usually, young people are taught that they should abstain sexually until they marry, and then remain faithful to their partner. This is a good way for someone to avoid HIV infection, as long as their husband or wife is also completely faithful and doesn't infect them.

HIV facts and myths

HIV facts and myths
People with HIV look just like everybody else

People with HIV look just like

everybody else

Around the world, there are a number of different myths about HIV and AIDS. Here are some of the more common ones :

'You would have to drink a bucket of infected saliva to become infected yourself' . . . Yuck! This is a typical myth. HIV is found in saliva, but in quantities too small to infect someone. If you drink a bucket of saliva from an HIV positive person, you won't become infected. There has been only one recorded case of HIV transmission via kissing, out of all the many millions of kisses. In this case, both partners had extremely badly bleeding gums.

'Sex with a virgin can cure HIV' . . . This myth is common in some parts of Africa, and it is totally untrue. The myth has resulted in many rapes of young girls and children by HIV+ men, who often infect their victims. Rape won't cure anything and is a serious crime all around the world.

'It only happens to gay men / black people / young people, etc' . . . This myth is false. Most people who become infected with HIV didn't think it would happen to them, and were wrong.

'HIV can pass through latex' . . . Some people have been spreading rumours that the virus is so small that it can pass through 'holes' in latex used to make condoms. This is untrue. The fact is that latex blocks HIV, as well as sperm - preventing pregnancy, too.

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