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What Does an HIV Diagnosis Mean Today?


In the early 1980s, when the medical community was just beginning to learn that there was a “new” virus that was destroying the immune systems of infected individuals, people who had HIV/AIDS usually didn’t live much longer than two years. In the past 20 years, developments in treatment have changed the face of what it means to have this illness. Many people are now able to live with it for years. It requires a tricky balancing of powerful AIDS drugs (with their often difficult regimen) and a healthy lifestyle, and plenty of hoping that the HIV virus will not become resistant to the drugs.

You may already know that HIV is the virus that causes AIDS, which stands for acquired immune deficiency syndrome. You can have the HIV virus in your body for a long time before actually having AIDS. The virus slowly wears down your immune system. Without a strong immune system, your body becomes unable to fight infections and parasites.

CDF+ cells and viral loads
Having the HIV virus means learning to become familiar with certain terminology and numbers. If you have HIV, you’ll hear a lot about your viral load and your CD4+ count. The viral load test measures the amount of HIV virus you have in your blood. The CD4+ count indicates how healthy your immune system is. People with healthy immune systems have CD4+ cell counts of between 500 and 1,500. These cells are an important part of the immune system. They help to fight all kinds of infections. People are said to have AIDS when their CD4+ count goes down to 200 or less.

The goal of HIV treatment is to keep the immune system functioning at a high level. That means the CD4+ count needs to be in the healthy range and the viral load needs to be low.

How HIV is treated
One of the challenges of treating an HIV positive patient is knowing exactly when treatment should begin, since many HIV positive individuals can go for years feeling completely healthy, with CD4+ and viral load counts in the healthy range.

There are different philosophies to treatment. One school of thought is the “hit hard early” theory. It’s a more aggressive way of treatment that says that you should start taking medication as soon as you know you have the HIV virus. The thinking is that immediate treatment will help to keep viral levels low.

The other school of thought is to begin treatment based on the numbers. When the counts get low, treatment begins. The advantage to this theory is that AIDS drug regimens can be difficult, and putting treatment off means sparing the patient the side effects and the need to take lots of pills day after day after day.

Patients and their doctors usually make the decision to begin treatment together. It can be a difficult one, which is why it’s important for anybody with HIV/AIDS to feel comfortable with their doctor. There needs to be a lot of open discussion all along the way.

Combination treatment most common
There are two classes of drugs—called antiviral medications--used to fight the HIV virus. The drugs usually fight the virus best when used together. This combination treatment is what’s often referred to as the “AIDS cocktail.” It consists of:

  • Reverse transcriptase inhibitors: These drugs interfere with an enzyme called reverse transcriptase. The enzyme helps instruct cells to create more particles of the virus.
  • Protease inhibitors: These attack the virus in the later stages of its development by preventing the protease enzyme from helping the virus infect other cells.

A challenging regimen
It’s important to keep the medication circulating in the bloodstream at all times. If you don’t, the virus is more likely to become “resistant” to the drugs, which means that the drugs are no longer as effective. This is why missing doses is a dangerous idea. This can be difficult, because you may have to take several pills per day. You need to take some of the pills on an empty stomach and some when your stomach has food in it. And the side effects can be quite troublesome.

People who are taking the combination therapy generally have to come up with a few “tricks” to help themselves remember to take the pills. They may time them when they watch certain television shows, when they have their morning coffee, when they get home from work, etc. It’s important to work with your doctor when you start on the regimen so you can set up a drug schedule that will suit your individual needs. Pillboxes, timers, and reminders from friends and family are also extremely helpful.

Managing difficult side effects
Side effects can make it hard to stick with the treatment as well. Diarrhea and nausea are common. These often get better as time goes by, but in some cases, they get worse. One of the more difficult side effects is called lipodystrophy. Protease inhibitors can cause this. It leads to large amounts of fat deposits in the lower belly and the upper back. Other side effects can include depression, confusion, bone problems and heart problems.

In some cases, supervised breaks from the medication can help patients tolerate their regimens better. Doctor can monitor their patients during these breaks and re-start the treatment if necessary. But the key word here is “supervised.” It’s never a good idea for patients to decide on their own to take a so-called “drug holiday.”

A recent study in the Journal of Acquired Immune Deficiency Syndromes showed that within a given year, about 10 percent of HIV-positive patients skip their dosages, change dosages or stop taking the medication completely because of side effects. Changing your regimen on your own can have serious consequences. The better solution is to tell your doctor you feel the need to stop a medication or change a dosage. It’s very common for people taking AIDS medications to go through a process of trial and error before finding a regimen they can tolerate.

Many questions remain
The National Institute of Allergy and Infectious Disease is currently conducting a nine-year, 21-site study that researchers are counting on to provide more precise information about AIDS treatments. It’s the first long-term study to examine effects of treatment on such things as the heart, body fat distribution and bone density. Participants will comprise two groups—a “hit hard early” group, which will have drugs that suppress HIV levels to low or undetectable levels, and a “go-slow” group, which won’t begin antiviral drugs unless their CD4+ cell count drops below 250 per cubic millimeter.

There is still a lot to learn about treating HIV/AIDS. When is the best time to begin therapy? When should you change from one drug to the other? What’s the best way to determine how the disease will progress? There’s been a lot of progress, but there’s still a long way to go.

Centers for Disease Control and Prevention; Journal of Acquired Immune Deficiency Syndromes 2002;31:211-2117; National Cancer Institute; National Institute of Allergy and Infectious Disease
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