Aids/HIV information, Symptoms, treatment

These tests use a small sample of blood taken from a vein in your arm to find out if you’ve been infected with HIV.The tests look for antibodies to HIV, not for HIV itself. HIV antibodies are made by B cells as your body tries to get rid of HIV. Labs use two tests to look for these antibodies. The ELISA test is done first, as a general screening test. (ELISA stands for “enzyme-linked immunosorbent assay.”) If the ELISA test is positive, a second test, called the Western Blot, is done to confirm the results. When both tests are positive, it means that the antibody to HIV has been found. Again, these tests don’t look for the virus itself, but for evidence in your blood that your immune system has reacted to the presence of HIV.

 Viral load tests show how much virus is in your blood. They can show whether you’re infected, even if your immune system hasn’t made antibodies to HIV. Remember that these tests look for HIV only in your blood, not in your lymphatic tissue. It is not clear at the time of writing whether these tests will be covered by provincial or private insurance plans.

A human body is made up of billions and billions of cells, but germs have only one cell. There are four different types of germs, or “microbes”: bacteria, fungi, protozoa, and viruses.

 Bacteria (the plural of bacterium), fungi (the plural of fungus), and protozoa (the plural of protozoan) are all single-celled creatures but each type behaves in different ways. Like all living things, these organisms breathe, eat, shit, and reproduce. Not all germs cause disease; in fact, some of them help keep us healthy.  Viruses are very different from the other three kinds of germs. Viruses do not breathe, eat, or shit, and they can’t reproduce on their own. Viruses are simple structures that straddle the line between living and non-living matter. A virus is made up of genetic material called DNA (deoxyribonucleic acid) or RNA (ribonucleic acid), wrapped in a coat of protein. In order to reproduce, a virus must enter a living cell and take over some of that cell’s parts. Only then can the virus make copies of itself.  HIV is a type of virus called a retrovirus. It is made up of two strands of the genetic material called RNA wrapped in a protein coat. This protein coat has spikes of something called gp120 all over it. These gp120 spikes work like keys. All of our body’s cells have receptors on them. These receptors act like locks to let some things in and keep others out. HIV, with its gp120 spike, or key, is able to enter cells that have what’s called a CD4 receptor, or lock.  There are several stages in the reproductive cycle of HIV. At each stage, chemical messengers called enzymes help the virus make copies of itself. As HIV enters a T4 (CD4+) cell, the virus sheds its protein coat. Then its genetic material, called RNA, must be changed to match the cell’s genetic material, which is called DNA. An enzyme called reverse transcriptase allows the viral RNA to become viral DNA. In the next stage another enzyme, called integrase, helps the new viral DNA join, or integrate with, the cell’s DNA. Once the viral DNA is joined with the cell’s DNA, the cell begins to reproduce the virus, making hundreds of copies of HIV. Another enzyme, called proteinase (or protease), helps put together the parts of the virus. When the new viruses are ready, they burst out of the cell and into your blood or lymph.

When you’re HIV-positive and make a decision to go on antiretroviral therapy, it’s a commitment you make to take your medication every day, exactly as your doctor says.

 It isn’t easy to take any medication every day. Sometimes it takes some planning, but the effort is worth it

This brochure is intended to help you gain the most benefit from your therapy. To do this you need to understand why it’s so important to take anti-HIV medication just as it’s prescribed and to stay on the medication.
 

 HIV is a very active virus. From the first day of infection with HIV, large numbers of the virus are produced in your body every day.

Whether or not you have symptoms, the virus rapidly produces copies of itself that attack and destroy your immune, or CD4 (T), cells. These cells are part of the body’s natural source of protection against infection. Without treatment, your body eventually won’t have enough CD4 cells to fight HIV, or any other infection.

New medications can help.

Treatment can reduce the amount of HIV in your body, sometimes very substantially. A lot of progress has been made in the development of new medications, which include protease inhibitors, a type or “class” of anti-HIV medication that may help keep HIV under control for long periods of time. Many older anti-HIV medications (for example, reverse transcriptase inhibitors [RTIs] such as AZT, 3TC , d4T, ddl, ddC) belong to another class of drugs.

 Studies have shown that, for many people, protease inhibitors can:

• Reduce the amount of virus in your blood, sometimes to undetectable levels. (Virus may still be present in other organ systems.)

• Increase the number of CD4 cells; CD4 cells help fight infection.

The goal of treatment is to keep viral levels as low as possible for as long as possible

It often takes more than one anti-HIV medication to meet this goal. But whether you’re taking one or more than one anti-HIV medication, protease inhibitors and other antiretrovirals are most effective when taken exactly as your doctor says.

When you don’t take enough anti-HIV medication, you may not achieve the full benefits that a drug can provide. For example, if you take a smaller dose than prescribed, miss a dose, or take a “drug holiday,” more virus copies may be produced, and the amount of virus in your body may start to increase.

In addition, the more copies of the virus that are made, the greater the possibility that the virus will become resistant to your medication.

To understand this, think of a production line making socks. For every 10 socks that are made on this production line, there is one mistake or “irregular” sock; for every 100 socks made, there will be 10 irregulars.

 So, as more socks are made, more irregulars are made. This is what happens with the virus,  and the irregulars are called mutations. Virus copies that have these mutations may not be affected by the medication.

If many of the viruses in your body have these mutations, your medication may not work as well. This is called drug resistance.

If this happens when you are taking a protease inhibitor, other protease inhibitors may be less effective against the virus, too. This is called cross-resistance and it can also happen in other classes of anti-HIV medications.

Cross-resistance happens between one or more drugs in the same class (such as protease inhibitor to protease inhibitor) but usually not between drugs belonging to different classes of anti-HIV medications (such as protease inhibitor to reverse transcriptase inhibitor).

 What all this means is that…

• If you do take all your medication, you’ll be able to help keep the virus from making so many copies. This can result in fewer mutations (”irregulars”), which may help prevent resistance, and may help keep your medication working longer.

If you don’t take all your medication as prescribed, there’s a greater chance that the amount of virus will increase and more mutations will be made. This may then lead to resistance and may keep your anti-HIV medication from working as well, or working at all.

 Taking anti-HIV medication, and following your doctor’s instructions, means remembering:

• To take your medication on time, every time.
• To take the right number of capsules or tablets with each dose.
• To take each of your anti-HIV medicines with or without food or liquid, as required.

Remembering to take your medication at the right times and in the right way may take some planning, but don’t stop taking your medication–even briefly–because it can interfere with the effectiveness of your anti-HIV medication. It’s really important that you…

• Don’t take “drug holidays.”
• Don’t skip doses.
• Do take your medicine on time.
• Do follow your doctor’s instructions about taking your medicine with or without food or liquid.
• Do plan ahead, and carry your anti-HIV medications with you if you think there’s a chance you might not be at home to take your next dose. This will help you to be sure to take them on time, every time.

Sometimes it helps to …

• Make a list of your medications and the times you take them, and put the list in a place where you’re sure to see it.
• Check off the list when you have taken your medication. That way, you can see if you’ve missed any doses and plan so that it doesn’t happen in the future.

Talk to your health care provider about ways to help you plan your medication times around meals, or ways to plan your meals around your medication doses.

• For initial determination, or baseline levels, two tests (2 - 4 weeks apart)
• Regularly, along with CD4 counts (every 3 - 4 months)
• 3 - 4 weeks after beginning or changing antiretroviral treatments to measure response to therapy

Every day as many as 10 billion new copies of the virus are produced by your body. Ask your health care provider about checking your viral load and reducing it through therapy.

Many health care providers now believe that viral load should be used in conjunction with CD4 counts as the signal to begin or change therapy.

A viral load test is a simple blood test that measures the amount of HIV in the blood. Results can range from 50 to well over one million copies per milliliter (mL).

Two tests used to measure viral load are bDNA, manufactured by Chiron Corporation, and PCR, distributed by Roche Diagnostic Systems, Inc.

Many health care professionals now believe that viral load should be used (in conjunction with your CD4 count) to determine when to start treatment and the best medications to use to treat HIV.

A higher or rapidly increasing viral load, for example, may indicate that your infection is advancing, which may prompt your physician to talk to you about starting or changing your treatment.

It is important to remember that current therapies are not a cure for HIV or AIDS. People taking these treatments may still develop infections or other conditions associated with HIV.

Because of this, it is very important for you to remain under the care of a doctor. Available treatments have not been shown to reduce the risk of passing HIV to others through sexual contact or blood contamination.

An important treatment goal is to reduce viral load to as low a level as possible, for as long as possible.

 Speak with your physician or health care provider about treatment options that are now available to reduce viral load.