HIV/Aids

Updated 04 January 2018

Treating HIV/Aids

HIV/AIDS is treated by anti-retroviral therapy and the management of opportunistic infections. It is also important to stay healthy to maintain a strong immune system.

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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.

The 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 possible
  • Reduce your risk of HIV-related infections
  • Improve your quality of life and make you live as long as possible
  • Prevent you from passing the virus on to others
  • Minimise the side effects related to your treatment

ART 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. 

ART 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 ART. It’s 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 effects.
  • 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.

A 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 therapy”).

In 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 for everyone.

Regardless 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.

There’s 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 opportunistic infections

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.

Severe 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.

Although 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.

WHO 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 complementary foods. 

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.

 

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HIV/Aids expert

Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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