HIV/AIDS

Diagnosis   

Although there is currently no cure for HIV, significant progress has been made in its treatment with the use of antiretroviral therapy (ART). ART involves taking a combination of oral medications daily, which is the most effective approach in inhibiting HIV replication and preventing damage to the body’s cells. Some combination pills contain multiple medications in one, personalized by healthcare providers for each individual. The primary goal of ART is to lower the viral load in the blood to undetectable levels through regular HIV testing, while also slowing down the virus’s impact on the immune system. Some common options for HIV testing include:  

• Antigen/antibody tests:  HIV tests typically require a blood sample from a vein to detect antigens, which are substances present on the HIV virus and become detectable within a few weeks after HIV exposure, resulting in a positive test. On the other hand, antibodies, produced by the immune system in response to HIV exposure, may take weeks to months to become detectable. Combination antigen/antibody tests usually yield positive results within 2 to 6 weeks after exposure to HIV. 
• Antibody tests:  HIV tests detect antibodies in blood or saliva, and most rapid tests, including self–tests done at home, are based on this principle. It can take anywhere from 3 to 12 weeks after exposure for antibody tests to yield positive results. 
• Nucleic acid tests (NATs):  These tests examine the viral load of the actual HIV virus in your blood and require a blood sample drawn from a vein. If you suspect recent exposure to HIV in the past few weeks, your healthcare provider may suggest NAT (nucleic acid test). NAT is the first test to detect HIV after exposure. 

Discuss with your healthcare provider to determine the most suitable HIV test for you. Even if any of the initial tests show negative results, it is important to consider a follow–up test weeks to months later to confirm the accuracy of the results. 

If one had a probable exposure within three months of testing, retesting to confirm the negative result is required. 

Upon receiving a diagnosis of HIV/AIDS, your healthcare provider may conduct several tests to determine the stage of the disease and the most appropriate treatment. These tests include: 

• CD4 T cell count: This test assesses the number of CD4 T cells, which are white blood cells targeted and damaged by HIV. The progression to AIDS occurs when the CD4 T cell count falls below 200, even if there are no noticeable symptoms. 
• Viral load (HIV RNA): Measuring the amount of HIV virus in your blood, this test helps monitor the effectiveness of HIV treatment. The goal is to achieve an undetectable viral load, which significantly reduces the risk of opportunistic infections and other HIV–related complications. 
• Drug resistance: Some strains of HIV may be resistant to certain medications. This test identifies whether your particular virus has developed resistance, assisting your healthcare provider in making informed decisions about your treatment plan. 
• Test complication: Your healthcare provider may order lab tests to screen for various infections and potential complications, such as tuberculosis, hepatitis B or C virus infections, sexually transmitted infections (STIs), liver or kidney damage, urinary tract infections, cervical and anal cancer, cytomegalovirus, and toxoplasmosis. These tests are essential in diagnosing and managing any underlying health conditions and ensuring appropriate and timely treatment. 

Treatment   

Currently, there’s no cure for HIV/AIDS. Once you have the infection, your body can’t get rid of it. However, there are many medications that can control HIV and prevent complications. These medications are called antiretroviral therapy (ART). Everyone diagnosed with HIV should be started on ART, regardless of their stage of infection or complications. 

ART is usually a combination of two or more medications from several different drug classes. This approach has the best chance of lowering the amount of HIV in the blood. There are many ART options that combine multiple HIV medications into one pill, taken once daily. 

Each class of drugs blocks the virus in different ways. Treatment involves combinations of drugs from different classes to: 

• Account for individual drug resistance (viral genotype) 
• Avoid creating new drug–resistant strains of HIV 
• Maximize suppression of virus in the blood 

Two drugs from one class, plus a third drug from a second class, are typically used. 

There are several types of medications used to treat HIV, each targeting specific stages of the virus’s replication process: 

• Non–nucleoside reverse transcriptase inhibitors (NNRTIs) work by inhibiting a protein essential for HIV to replicate itself. Examples of NNRTIs include efavirenz, rilpivirine, and doravirine. 
• Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are modified versions of the building blocks that HIV requires for replication. NRTIs include medications such as abacavir, tenofovir disoproxil fumarate, emtricitabine, lamivudine, and zidovudine. Combination drugs are also available, which combine multiple medications into a single pill. Examples of combination drugs include emtricitabine/tenofovir disoproxil fumarate and emtricitabine/tenofovir alafenamide fumarate. 
• Protease inhibitors (PIs) target and disable another critical protein (protease) required for HIV replication. Commonly used PIs include atazanavir, darunavir, and lopinavir/ritonavir. 
• Integrase inhibitors function by blocking the activity of a protein called integrase, which HIV employs to insert its genetic material into CD4 T cells. Examples of integrase inhibitors include bictegravir sodium/emtricitabine/tenofovir alafenamide fumarate, raltegravir, dolutegravir, and cabotegravir. 
• Entry or fusion inhibitors prevent HIV from entering CD4 T cells. Notable examples of these inhibitors are enfuvirtide and maraviroc. 

Starting and maintaining treatment 

Everyone with HIV infection, regardless of CD4 T cell count or symptoms, should be offered antiviral medication to maintain an undetectable viral load. Taking the prescribed medications consistently is crucial to keep the immune system strong, reduce infection risks, prevent treatment–resistant HIV, and lower the chances of transmitting the virus to others. Despite challenges, such as side effects or mental health issues, maintaining ART with regular follow–up appointments and open communication with healthcare providers is vital to address any difficulties and ensure a healthier outcome. 

Treatment side effects 

HIV medication can cause various side effects, including problems like feeling sick, heart issues, harm to the kidneys and liver, weaker bones, unusual cholesterol levels, higher blood sugar, and difficulties with thinking, emotions, and sleep. 

Treatment for age-related diseases 

As you get older with HIV, dealing with some health problems might become harder. Medications used for age–related issues, like heart or bone conditions, may not mix well with HIV drugs. That’s why it’s important to talk to your healthcare provider about all your health conditions and the medicines you take. If another provider gives you medications, make sure they know about your HIV treatment to avoid any harmful interactions between the drugs. Good communication between all your healthcare providers is crucial for your well–being. 

Treatment response 

Your health care provider will regularly assess your viral load and CD4 T cell counts to evaluate your response to HIV treatment. These tests will be conducted initially after 4 to 6 weeks and subsequently every 3 to 6 months. The goal of the treatment is to reduce the viral load to an undetectable level in the blood, but this doesn’t imply that HIV is completely eradicated from the body. It may still be present in other areas, like lymph nodes and internal organs.