Discuss your HIV status with your partner(s). While this may be difficult to do, it is important that they be tested so that they can also be treated if necessary. In addition, they in turn may be unknowingly putting others at risk of HIV.
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Protect your partner(s) from HIV by practising safer sex.
Stay healthy to maintain a strong immune system: eat a healthy, balanced diet, get enough rest and exercise, and avoid cigarettes and alcohol.
Medication
Anti-retroviral drugs slow down the rate at which the virus multiplies. Even though these drugs cannot completely eliminate the virus, by slowing down its multiplication they can prolong the symptom-free period of the disease. The presence of symptoms of HIV disease and the CD4 count are used to decide when to start anti-retroviral drugs. Even if there are no symptoms, according to international guidelines that are revised every year, a CD4 count between 200 and 350 would indicate the need for drug treatment. These guidelines also give information on which drugs are suitable to start therapy with and how to monitor individuals on these drugs.
It is believed that it is not best to start treatment too early so as to avoid the possibility of viral resistance developing to certain important groups of drugs and to minimise the drug side effects to an individual.
Anti-retroviral drugs include:
Nucleoside reverse transcriptase inhibitors (NRTIs) such as zidovudine (AZT) and lamivudine (3TC)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as nevirapine
Protease inhibitors (PIs) such as indinavir
The two groups of reverse transcriptase inhibitors handicap (inhibit) the viral enzyme that allows the virus to repeatedly copy itself into the DNA of T-helper lymphocytes.
The protease inhibitors handicap the viral enzyme that allows young viruses to mature to the state in which they can infect new cells.
In the best circumstances a person is given a combination of these drugs. This is because the drugs assist each other against the virus, so it takes longer for the virus to become resistant to any one drug. Ultimately a person’s virus may become resistant to these drugs so that they are no longer effective, in the same way that insects become resistant to a pesticide and bacteria become resistant to a frequently used antibiotic.
These drugs can be expensive and laboratory monitoring while on the drugs can also be costly. If you do not have medical aid, and private health care, you can now obtain treatment through certain designated government hospitals and clinics. However, these government treatment centres are not yet up and running in all areas. Instead, there may be a non-governmental organisation (NGO) free treatment programme in your region.
You may have the opportunity to participate in a drug trial, usually at a large hospital. In a drug trial new drugs or new combinations of drugs are tried out on a group of patients. These trials are closely monitored to ensure that those participating benefit from the drugs, and are not harmed or exploited.
HIV drugs and mother to child transmission (MTCT)
Pregnant women who are HIV positive can reduce the risk of infecting their babies by using anti-retroviral drugs during pregnancy and labour. In addition, the baby may be given an anti-retroviral drug for a few days after birth to counteract exposure to the virus during labour. There are different drugs and treatment approaches that can be used in this situation, but the most world-wide experience has been obtained with the drug AZT, and more recently, nevirapine. Infection of babies can be reduced by approximately 50% by using a short course of either of these drugs.
The most effective drug regimen is to place the mother on combination antiretroviral therapy (HAART) which reduces the risk of transmitting HIV to the baby to less than 2%.
A planned caesarean section will also reduce the risk of HIV being transmitted to the baby, as most infections occur during labour itself.
New data from studies conducted in Soweto, South Africa, using only one dose of drug (nevirapine) to the mother during labour and one dose of nevirapine to the infant after delivery has shown to decrease transmission by almost 60%. This is easily administered short schedule has been implemented in this country to prevent mother to child transmission of HIV. One concern about the use of nevirapine for PMTCT (preventing mother to child transmission) is that the virus in both mother and child may develop resistance to the drug, and then it is not suitable for use if they should need treatment.
Babies can be infected through breastfeeding, so most specialists strongly recommend that mothers who are HIV positive should only bottle feed their babies. If pure bottle feeding is not an option, then pure breastfeeding is recommended, and mixed feeding (breast and bottle) should be avoided. Mixed feeding increases the chance of HIV transmission through the mother’s milk compared with exclusive breastfeeding. The recently implemented Department of Health MTCT programme in South Africa provides a dose of nevirapine for a mother and her infant as well as a supply of formula milk at a subsidised cost. Most antenatal clinics in the country also have a “training” programme to show mothers how to use this milk properly. So although the benefits of breast milk are unfortunately lost in these infants, receiving formula or bottle milk at least ensures they are not exposed to HIV.
MTCT is a very complex problem. If you are HIV positive and pregnant you would need to discuss the issues at length with a health care professional knowledgeable in the area.
Health care workers who are accidentally exposed to HIV through, for example, a needleprick accident should start one or more anti-retroviral drugs (usually AZT and 3TC) as soon as possible after the incident and preferably within 72 hours. The drugs are usually taken for one month. From analysing thousands of such accidental exposures to health care workers, it has been calculated that even though the risk of getting HIV infection from such an accident is quite low (0.3% of cases), taking anti-retroviral drugs reduces the risk of infection by about 80%.
Women who have been raped should also start anti-retroviral drugs as soon as possible. Most specialists believe that this is highly likely to reduce the risk of HIV infection, just as the drugs reduce infections after needleprick accidents and reduces transmission of HIV from a mother to her newborn baby. Recently some experimental work in monkeys and data from rape clinics have confirmed this theory, and showed that the drugs must be taken early (definitely before 72 hours, and preferably within 36 hours) to be effective.
The South African government now funds anti-retroviral drugs in the context of rape. However, this treatment may be difficult to obtain outside of large hospitals. There are special rape centres where treatment is available, and the police in your area should be able to help.
Prevention of opportunistic infections
Prevention of opportunistic infections covers primary prevention (preventing illness before it occurs) and secondary prevention (preventing a disease that a person has already had from coming back).
Children should receive their routine vaccinations, but if they already have AIDS, they should not get the vaccine against TB. Extra vaccinations may be recommended in both adults and children. All children, as well as adults who have started to show the signs of HIV disease, should take an antibiotic called co-trimoxazole continuously. This antibiotic prevents Pneumocystis jerovici pneumonia. Adults or children who have had TB or who have contact with people with TB (especially at home) should take anti-TB drugs as well.
Nutrition
In addition to maintaining a healthy lifestyle, good nutrition is important to ones health and immune system. A well formulated multivitamin taken daily along with a high protein diet is important in persons infected with HIV. Medication that is thought to boost the immune system has not been shown to be of any benefit and may actually be detrimental to persons infected with HIV. In particular, a drug called Moducare, which is made from the African potato plant, has recently been shown to have toxic side effects in certain HIV-infected persons. In addition, African potato can significantly inhibit the effectiveness of antiretroviral drugs.
Follow-up
Follow-up treatment and examinations will include regular visits to a doctor to monitor the progress of HIV disease, to diagnose and treat other infections and to keep up to date with new treatments.
Regular dental examinations are necessary, because people with HIV have a higher rate of mouth problems, including gum disease.
Other
HIV-positive people often have to deal with being treated differently by others (discrimination) or even shunned because they carry an infectious disease that is transferred by sex. There is also the anxiety about the threat of illness and death. It may therefore be important to get emotional support from a psychologist or a support group.
It may happen that, when it is known that people have HIV, their colleagues do not want to work with them or their employer will want to fire them. Information on legal and human rights for people living with HIV/AIDS may be obtained from an AIDS service organisation.
Reviewed by Dr Craig Corcoran, Clinical Virologist, National Health Laboratory Service and University of Cape Town, October 2006.
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