HIV/AIDS is treated with antiretroviral treatment (ART)
and medication that helps to keep opportunistic infections (diseases that occur
in people with suppressed immune systems) under control.
Without treatment, almost everyone with HIV will get AIDS.
ART isn't a cure, but it can control the virus so that you can live a longer,
healthier life and reduce the risk of transmitting HIV to others.
goals of ART treatment are to:
- Consistently suppress the viral load
(the amount of concentration of HIV in your blood)
- Keep your immune system as strong as
- Reduce your risk of HIV-related
- Improve your quality of life and make
you live as long as possible
- Prevent you from passing the virus on
- Minimise the side effects related to
involves taking a daily combination of HIV medicines, called an HIV regimen.
These HIV medicines prevent the virus from multiplying (making copies of
itself), which reduces the amount of HIV in the body. Having less HIV in your
body gives your immune system a chance to recover and fight off infections and
cancers. It also allows you to remain symptom-free for longer.
is recommended for anyone who has HIV, without delay, regardless of how long
they’ve had the virus or how healthy they are. If left untreated, HIV will
attack the immune system and eventually progress to AIDS. Once treatment has
started, it must be continued for the rest of your life. If you feel unsure
about taking the treatment, talk to your doctor or clinic nurse about your
feelings and concerns. It might also help to talk to someone else who is using
important to take the medication exactly as prescribed to prevent drug
resistance. The presence of symptoms of HIV disease and your CD4 count will be
used to determine when to start your treatment. In South Africa, ART is advised
when the CD4 count is less than or equal to 350 cells/mm3 or in people who have
an AIDS-defining illness (irrespective of the CD4 count). These include a
variety of conditions that occur at late stages of HIV disease and which signal
a progression to AIDS.
Factors to consider when starting ART:
Treating HIV/AIDS usually requires a
fairly complex medication regimen. Several different tablets must be taken at
different times of day, some with food and others on an empty stomach. Some
tablets must be taken at exactly the The drugs often have unpleasant side
effects such as nausea and headache. Speak to your doctor or clinic nurse if
you’re unsure how to deal with them.
- Note that your medication must be
taken for the rest of your life to control the HIV infection.
- It may be necessary to change your
treatment over the course of your life. You therefore have to be motivated and
dedicated to taking your treatment as directed. Be open and honest with your
clinic doctor or nurse.
- Remember that the virus can never be
completely eradicated from your body. A reservoir of infected cells will always
remain, even if the virus can’t be detected in your blood.
- Tell someone you trust that you’re on
ART. Ask them to remind you to take your medication every day, to join you when
you visit your clinic or doctor, and to help you if you experience side
- Talk to your doctor about your risk
for other diseases as a result of taking ART (e.g. diabetes type 2) and find
out what you can do to lower your risk.
- Try not to ever miss a clinic or
doctor’s visit, and try to go to the same facility every time (the facility
will keep a record, helping you to track your progress).
Combination therapy – a cocktail of drugs
If you’re HIV positive, you’ll receive a combination of three or more
antiretroviral drugs that target different steps in the virus’s replication
cycle. This is known as or HAART – highly active antiretroviral therapy.
combination of drugs are prescribed because the HIV virus very quickly becomes
resistant to a single drug (monotherapy). The drug becomes ineffective and
can’t be used for your ongoing treatment. However, if two or more drugs are
used together, the virus multiplies very slowly and takes much longer to become
resistant to any one of the drugs you’re using. Therefore, at least two drugs
should be taken together (“dual therapy”), and preferably three (“triple
South Africa, fixed-dose combination antiretroviral
drugs (a combination of two or more active drugs in a single pill) is now used
as the first line of treatment in people with HIV. This means that, if you’re
HIV-positive, you can take just a single pill once a day instead of three or
more pills several times a day. This pill combines tenofovir (TDF), emtricitabine
(FTC) and efavirenz (EFV). Note that the fixed-dose combination pill isn’t suitable
of the antiretroviral treatment you’re on, your doctor or nurse will monitor
your side effects, look for evidence of a response to the therapy (i.e. they’ll
check to see if your CD4 cell count is increasing, which indicates a recovering
immune system), and keep an eye on the presence of opportunistic infections.
a slightly higher risk for opportunistic infections in the weeks following the
start of ART, as your immune system recovers and turns to attack the invaders
in the body. This is known as immune reconstitution inflammatory syndrome
(IRIS) and could involve the sudden, unexpected flare-up of a previously
undiagnosed condition or the worsening of a previously treated disease.
When to start treatment
On 1 September 2016, South Africa adopted the World
Health Organization’s Consolidated
Guidelines on the Use of Antiretroviral Drugs, which state that all people who are diagnosed with HIV are immediately
eligible for antiretroviral therapy (ART), regardless of their CD4 count.
South Africa was also among the first countries in Africa to
formally adopt the WHO
Universal Test and Treat (UTT) Guidelines, which
support the UNAIDS 90-90-90
targets of 2020. The aim is to ensure that 90% of all people living with HIV
know their status; that 90% of people with diagnosed HIV infection receive
sustained ART; and that 90% of all people receiving ART have viral suppression.
These steps are supported by research studies that showed that early use
of ART keeps HIV-positive people alive and healthy, while reducing their risk
of transmitting the virus to their partnersManaging
If you’ve tested positive for HIV, a
thorough medical examination should be done to evaluate your current state of
health. As other sexually transmitted infections (STIs) and TB are often
present in HIV-positive people, additional screening tests will be done. These
must be treated straightaway.
opportunistic infections need to be treated before ART can be started. If your
CD4 count is very low (less than 200 cells per microlitre of blood), your
doctor will start prophylaxis for Pneumocystis jiroveci (PJP),
formerly known as Pneumocystis carinii pneumonia (PCP). This
organism can cause life-threatening lung disease.
HIV drugs and
mother-to-child transmission (MTCT)
If you’re pregnant and HIV-positive, you
can reduce your risk of infecting your baby by using ART during pregnancy and labour.
At 14 weeks of pregnancy, or as soon as possible, you will
be given zidovudine (ZDV) if you’re not on ART. This drug is also usually given
to pregnant women every three hours during delivery. Taking a single dose of
nevirapine during stage 1 of labour, as well as a single dose of tenofovir and
emtricitabine, can further reduce the risk of transmission.
Your baby should also be given nevirapine at birth, and
then every day for six weeks. Thereafter, an HIV PCR test will be done to
determine the ongoing management of your little one. Note that a planned
caesarean section cuts the risk of HIV being transmitted to your baby, as most
infections occur during vaginal delivery.
babies can be infected with HIV through breast milk – and the use of formula
milk has long been advocated in HIV-positive mothers with HIV-negative babies –
this guideline recently changed. Research has shown that a combination of
exclusive breastfeeding and ART can significantly reduce the risk of HIV
transmission from mother to child. Note, however, that there are still risks
involved: talk to your doctor and/or nurse to make sure you follow the correct
steps to keep your child healthy.
furthermore recommends that all mothers, regardless of their HIV status,
practise exclusive breastfeeding for the first six months of their child’s
life. This means that you shouldn’t give your baby any other liquids or foods
during this time. After six months, you can start giving your baby
When to call your doctor
When you first start HIV treatment, you may suffer from headaches,
an upset stomach, fatigue, or aches and pains. These side effects vary from
person to person: for some, they're mild and usually go away after a few days.
But they can last up to a month for others.
Before you start treatment, speak to your doctor about potential side
effects so you know what to watch out for.
Don’t stop taking your HIV medication even if you are struggling
with side effects – this could lead to drug resistance and make the virus
harder to treat. First contact your doctor or healthcare provider. They’ll
advise you on how to reduce or cope with the side effects, or you may be able
to change your treatment regimen. Note that many of the newer HIV medications
have fewer side effects.
If your symptoms don’t get better, or if you experience any
unusual or severe reactions after starting or changing a drug, let your doctor
or healthcare provider know immediately. The bottom line is that it’s better to be safe
than sorry. Everyone is different and we all respond to medication in different
ways. So, if you’re worried about anything, rather call your doctor or
healthcare practitioner and get advice. They’re there to help and guide you.