Information for employees of the UN system and their families
HIV and AIDS treatment
What treatments exist for HIV/AIDS?
Several different types of drugs exist to treat HIV infection. All
these drugs attack various aspects of the process used by the virus to
create new copies of itself. Because HIV quickly mutates to become
resistant to any single drug, patients must take a combination of
drugs to achieve maximum suppression of HIV.
Combination anti-HIV therapy is known as antiretroviral therapy, or ART. ART changes the natural course of HIV infection, significantly extending the period between initial infection and the development of symptoms. To achieve these results, it is important to initiate therapy before AIDS symptoms develop, although even patients who start on therapy after being diagnosed with AIDS often receive major and long-lasting health benefits. Although effective in slowing the progression of HIV/AIDS, ART is not a cure.
In addition to treating HIV infection itself, therapies exist to
prevent and/or treat many HIV-related opportunistic infections.
If I test HIV-positive, does this mean I need to start on
medication immediately?
Those of us who test HIV-positive should immediately seek out a
physician who is experienced in HIV/AIDS for initial tests and
consultation. If you test HIV-positive, you will be referred
immediately to a physician. Usually, the physician will want to
perform a second HIV test to confirm the positive diagnosis.
The physician will also draw additional blood to perform other tests to assess the state of the immune system. These tests will include a CD4 count and a viral load measurement. The CD4 count tells us how many immune system cells are at work in the blood. When our CD4 count is depressed, it tells us that something has impaired our immune system. The viral load test measures how much HIV is circulating in the blood. A lot of virus in the blood indicates that HIV is actively making copies of itself and infecting and killing new cells. The more HIV in the blood, the quicker the disease will progress. Although the drugs to fight HIV are extremely effective, they can also have side-effects. As physicians and nurses have gained more experience in managing HIV/AIDS, they have come to recognize that the drugs may be more effective if they are used somewhat later in the course of infection than initially thought. By monitoring your blood on a regular basis, and by tracking whether your body is beginning to feel the effects of HIV infection, your physician will be able to advise when it is time to begin treatment.
If I’m HIV-positive and my physician prescribes medication for my
condition, can I begin anti-HIV treatment slowly—say, by taking only
one pill at a time?
Because HIV is constantly mutating, it quickly becomes resistant to
any single drug. When resistance develops, the drugs stop working as
effectively and the virus begins to rebound. To prevent or slow down
the development of such resistance, your doctor will prescribe at
least three different anti-HIV drugs. By attacking HIV from different
angles, combination therapy achieves maximum impact and reduces the
likelihood that drug resistance will develop.
Isn’t taking three drugs at once complicated?
Combination HIV therapy is not simple. Those of us who are
HIV-positive and on therapy will need to take multiple drugs at least
twice a day. Depending on our regimen, we may have certain eating
restrictions (such as the need to take drugs with food) and may have
to refrigerate one or more of our drugs.
 For those of us who are HIV-positive, it is essential that we take our drugs exactly as our physician prescribes them. If we miss doses, fail to take them on time, or otherwise vary our treatment regimen, the drugs will not be as effective as they should be and resistance will develop more quickly.
If I’m HIV-positive, how can I make sure I’m able to take my
medication as prescribed?
Taking medication as prescribed is often referred to as ‘treatment
adherence’. Studies show that most people do not adhere well to
therapy, regardless of their medical condition, level of education, or
annual income. Because treatment adherence is so critically important
in the case of HIV/AIDS, extra care must be taken to make sure that
HIV drugs are taken exactly as prescribed.
Once those of us who are HIV-positive are prescribed a combination
medication regimen, it is a good idea for us to make a personal
treatment-adherence plan. The nature of this plan will depend on our
own individual treatment regimen and on the dynamics of our individual
lives. For some people, creating a daily calendar is a useful way to
work treatment into our daily routines. For others, it is helpful to
use a daily or weekly planner to keep up with our treatment schedule.
Some people use a beeper or alarm clock to remind them when it is time
to take a dose, while others rely on friends, family members, or
roommates to help them remember. Before you leave your doctor’s office
with your new treatment regimen, it is a good idea to discuss your
treatment-adherence plan with a doctor, nurse or counsellor.
Developing a treatment-adherence plan requires that we honestly look at our lives and identify things that might interfere with our ability to take our drugs on time. If we tend to become absent-minded after drinking a little too much alcohol in the evening, for example, it might be wise to avoid situations in which we are likely to drink to excess. If we find it difficult to keep to a schedule because our lives are sometimes chaotic, it might be useful to try to stick to a more standard routine, such as having meals at particular times to remind us to take our drugs. Above all, it is important for those of us who are HIV-positive to remember that we are not the only ones facing these challenges. A lot of other people with HIV/AIDS are in the same boat. Getting together with other people living with HIV/AIDS to share our experiences and learn from theirs (with respect to adherence and a lot of other issues) can be an extremely healthy way to cope with HIV infection and to learn new strategies to protect our health.
I understand having HIV can make you prone to other infections. If
I’m HIV-positive, how will I protect myself from those?
For those of us who are HIV-positive, we are most prone to infections
once the virus has seriously damaged our immune system. For most
individuals, combination HIV therapy significantly strengthens the
immune system and reduces the vulnerability to opportunistic
infections. If you are HIV-positive, you should regularly see a doctor
qualified to treat HIV/AIDS so that your immune system can be
monitored on an ongoing basis. Routine monitoring of your immune
system will enable your doctor to prescribe treatments to prevent many
of the opportunistic infections that can strike people living with
HIV/AIDS.
The susceptibility of people with HIV to opportunistic infections
underscores the importance of knowing our HIV status. Many people with
HIV who delay testing only learn they are positive when they
experience a serious, sometimes life-threatening, illness. By knowing
our HIV status, we can take better care of our health and ensure that
we are monitored periodically; if we are HIV-positive, our doctors can
prescribe medication that can prevent these opportunistic illnesses
from ever happening.
One potential opportunistic illness that requires particular attention is tuberculosis (TB). TB is the leading cause of death among people living with HIV and is common in many parts of the world. Most people who have been infected with TB never develop the active disease because their immune systems fight off the infection. HIV infection, however, significantly increases the odds that latent TB infection will turn into active TB. All of us who are HIV-positive should be screened to see if we have been exposed to TB. Preventive therapies exist for people who have been exposed to TB.
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