Goals of Treatment
No one knows how to cure HIV or AIDS. However, there are many therapies, both conventional and alternative, that effectively prolong and enhance the quality of the lives of people with HIV and AIDS. The goals of treatment are to:
Slow the replication rate of HIV
Prevent and treat opportunistic infections
Relieve symptoms and generally improve quality of life
Treatment Overview
If you have HIV/AIDS, the standard of care in the United States is to provide you conventional drug therapies, especially if your T-cell count has fallen below 500. You will take most HIV/AIDS drugs in combination, to most effectively reduce viral blood levels, increase helper T-cell counts, and decrease the AIDS death rate. Because combinations of HIV/AIDS drugs are as important as the individual drugs themselves, it is extremely important that you stick to your medication regimen:
Take drugs at exactly the prescribed times of day
Never skip doses
Never skip drugs
For surveillance and routine management, you won’t need to stay in the hospital. Some more severe complications will require a hospital stay.
Drug Therapy
Anti-HIV drug therapy attacks HIV at various stages of its life cycle. Although the drugs have improved the health of many people, they can also cause severe side effects, including nausea, stomach cramps, diarrhea and abnormal body fat redistribution.
Drugs most commonly prescribed
These antiviral drugs have proven effective specifically for HIV infection:
Protease inhibitors:
Crixivan (Indinavir)
Fortovase and Invirase (Saquinavir)
Norvir (Ritonavir)
Viracept (Nelfinavir)
Non-nucleoside reverse transcriptase inhibitors:
Rescriptor (Delavirdine)
Sustiva (Efavirenz)
Viramune (Nevirapine)
Nucleoside reverse transcriptase inhibitors:
Videx (Didanosine, also known as DDI)
Epivir (Lamivudine, also known as 3TC)
Zerit (Stavudine, also known as d4T)
Hivid (Zalcitabine, also known as DDC)
Retrovir (Zidovudine, also known as AZT or ZDV)
Combivir (Lamivudine and Zidovudine)
In addition to the drugs used to combat HIV, your doctor may prescribe other drugs (such as antibiotics) to treat opportunistic infections.
If you regularly miss doses in your treatment regimen, the virus may develop resistance to drugs that were previously effective against it. To lessen the chances of resistance, you must closely stick to your regimen, or — in consultation with your doctor — stop all antiviral medications at the same time.
Strains of HIV have emerged that are resistant to many available drugs.
New drugs in development
Vaccines (therapies used to prevent the infection)
Passive hyperimmune globulin
Gene therapy engineered to destroy the HIV genome in HIV-infected patients
Healthcare Professionals Who May Be Involved in Treatment
Many members of the healthcare profession help treat people with HIV and AIDS. Primary care providers include:
Internists
Family practice physicians
Infectious disease specialists
Specialists include:
Gastroenterologists
Pulmonologists
Neurologists
Hematologists
Rheumatologists
Ophthalmologists
Psychiatrists
Psychologists
Activity & Diet Recommendations
The most accepted medical practices for avoiding HIV infection are:
Abstaining from sex
Using latex condoms for sexual intercourse
Using dental dams (thin squares of latex) for oral-vaginal or oral-anal contact
Using spermicidal jelly containing nonoxynol-9
Avoiding sharing needles
Avoiding unscreened blood products
Avoiding the blood of people with HIV
If you have HIV, regular exercise is important to maintain your muscle mass, improve circulation, and increase your general well-being. (In fact, some studies show that aerobic exercise may raise blood levels of certain white cells that fight infections.) Walking or bicycling are good choices. You should also rest between activity sessions.
Good nutrition is vitally important to those living with HIV and AIDS. HIV infection may cause you to burn an astounding 5,000 calories a day. What’s more, a healthy immune system is dependent on many nutrients.
A recommended diet is for aids patients:
Rich in whole, natural foods, such as fruits, vegetables, grains, beans, seeds, and nuts
High-calorie, high-protein (a whey protein supplement — 1 gram per 2 pounds of body fat — can help counteract AIDS wasting syndrome and heal the gastrointestinal tract)
Low in fats and refined sugars
You should also drink five or six 8-ounce glasses of water a day. Nutritionists recommend a daily multivitamin mineral supplement as well.
AIDS-HIV and Poor appetite
Dietary recommendations are all well and good, but AIDS may cause you to lose your appetite. Worse yet, AIDS may alter your sense of taste so that even favorite foods lose their appeal. Here are some suggestions:
Make breakfast your biggest meal
Eat small, frequent meals throughout the day
Don’t fill up on liquids during meals
Snack on nutritional supplement beverages, such as Ensure
Well-cooked poultry or fish might be more appealing than red meat
High-protein foods served at room temperature or colder might make them more appealing
Above all, eat safely
Healthy individuals who are exposed to contaminated foods might suffer an uncomfortable bout of food poisoning and quickly recover. However, such exposure could kill you if HIV has already damaged your immune system. Therefore, you should avoid:
Raw eggs
Unpasteurized milk or juices
Undercooked meats, poultry, or fish
Potentially contaminated foods
AIDS-HIV and Monitoring the Condition
Managing your health when you are living with HIV and AIDS is a complex and ongoing process. Over the course of your illness, your doctor will probably encourage the following measures:
Rechecking your T-cell counts and viral load periodically — at least every three months — if your T-cell count falls below 200
A complete physical exam at each visit
A review of all possible symptoms of HIV and AIDS at each visit
An assessment of any medication-related side effects at each visit
Possible Complications
Opportunistic infections
Neuropsychiatric symptoms
HIV-associated malignancies
Quality of Life
A diagnosis of HIV infection or AIDS can strike a huge psychological blow. In addition to the emotional toll of living with a fatal disease, the prejudice, fear, and misinformation surrounding AIDS can cause despair. Most practitioners agree that in addition to conventional drug therapies, you should consider psychological counseling and group support. Many communities now offer AIDS support groups that can help you maintain a positive mental outlook — an important component in maintaining your physical well-being.
AIDS-HIV and Considerations for Women
HIV-infected women are vulnerable to precancerous changes in the cervix that can progress rapidly to invasive cancer. Therefore, you should have a Pap smear soon after diagnosis and annually thereafter.
HIV-infected women are also vulnerable to pelvic inflammatory disease (PID), which may require prolonged antibiotic therapy and even surgery.
AIDS-HIV and Pregnancy
For those interested in contraception, the effective use of condoms is important not only in that it prevents pregnancy, but it also prevents HIV transmission to an uninfected partner and prevents transmission of other sexually transmitted diseases.
There is no evidence that pregnancy or childbirth has a negative effect on the progression of HIV infection. It may, however, pose an increased risk of bacterial pneumonia in HIV-infected women during pregnancy.
Mother-to-infant transmission of HIV infection happens 25-30% of the time if the mother does not follow treatment or preventive measures. Zidovudine (AZT) seems to reduce the rate of transmission during pregnancy to 8%. AZT alone may be preferred for women who would not otherwise start antiviral therapy.
HIV-infected mothers are at an increased risk for stillbirth, premature birth, and low-birth-weight infants.
AIDS-HIV and Nursing mothers
You should not breastfeed, because HIV has been found in breast milk and you can pass it to the baby during breastfeeding.
Considerations for Older People
HIV infection progresses more rapidly in those over age 50.
Considerations for Children and Adolescents
Only about 1% of AIDS cases in the United States have happened in children under age 13.
In infants, HIV is most commonly transmitted from an infected mother to the fetus through the placenta. Many children contracted AIDS through HIV-bearing blood or blood products before blood-screening systems began in 1985. Since then, most children contract AIDS in the womb, or in rare cases, from adult sexual abuse.
If your child is at risk for HIV infection, see your doctor regularly, even if your child feels well. Should infection be diagnosed, early intervention is particularly important in children.
In the same way that adults living with HIV and AIDS can benefit from psychotherapy or counseling, children can as well. Counseling can ease the anxiety and potential depression resulting from such a deadly disease in one so ill prepared to understand it. Social agencies in your area can also direct you to support groups for families of children living with HIV and AIDS.