Fact Sheets: Treatment Options

The Good News

New treatments for HIV have slowed the rate of progression from initial infection to a diagnosis of AIDS.  As a result, the number  of new AIDS cases and AIDS-related deaths has dropped dramatically, while an increasing number of people who are HIV-positive are living longer and healthier lives.

However. . .

There is still no cure. And while some who use drug combination therapy do very well and feel healthy, others develop substantial side effects and may not be able to stay on one or more of their medications. For still others, the combination therapy simply does not work. Many find the new drug regimens too demanding to take correctly, even though not doing so weakens the benefits of taking the drug. In addition, these drugs are very expensive. Many people who do not have adequate health insurance cannot afford the average cost of $12,000 or more per year for drug combination therapy.

Because the new combination therapies have been studied for only 3-4 years, their long-term effectiveness is unknown. Also undetermined is the safety of taking these drugs for many years and possibly for the rest of an individual's life. There may be health consequences.

Staying Healthy Longer

People who are HIV-positive can live healthy, productive lives for many years. A person infected with HIV can do many things to help stay healthy longer:

• Exercise regularly to stay strong and fit.

• Make sure you have a doctor who knows how to treat HIV, and follow your doctor's instructions. Keep your appointments.

• Be an active partner in your health care -- ask questions about anything you don't understand.

• Take the medications exactly as your doctor or other health care provider tells you to take them. If you get sick from your medications, call your doctor for advice rather than relying on the advice of your friends or family members.

• Don't smoke cigarettes or use drugs. Your body can fight the virus more effectively if you stop smoking and/or taking drugs. Seek help if you can't stop on your own.

• Get enough sleep and rest.

• Eat a balanced diet and seek a nutritional assessment from a registered dietitian specializing in HIV.

• Learn stress-management techniques. Many people find it easier to cope with the chronic stress of living with HIV/AIDS if they have a good social support network or engage in activities such as prayer or meditation.

• Women should get a Pap test once a year. Women infected with HIV are more likely to have an abnormal Pap test than women who do not have HIV.

Viral Load Tests

Viral load is the concentration of HIV circulating in the blood of an individual infected with HIV. Physicians use viral load testing in conjunction with CD4 cell counts to monitor the progress of the HIV and to help decide when or if to change medications.

Viral load tests help health care providers more accurately predict what might happen if the current treatment program is maintained. Currently, the goal is to keep the level of HIV in the blood at an undetectable level. An undetectable level of HIV in the blood does not mean that someone is no longer infected with HIV.  It simply means that the viral load is below the level that is detectable by current viral load tests.

Drug Combination Therapies

Drug combination therapies are often referred to as "highly active antiretroviral therapies" (HAART). HAART is also referred to as "drug cocktails" and includes drugs such as protease inhibitors. Researchers and clinical staff are very hopeful about this type of combination therapy. These drug combinations have been more effective than any of the other previously available therapies.

Risks of Non-compliance

It is important not to underestimate the complexity of the new drug treatments. It is very challenging to take all of the medications at the correct times throughout the day and in the correct manner. However, people who take their medications correctly every day have the best chance of reaching and sustaining an undetectable viral load and having the best treatment outcomes.

People who miss doses of any of their medications may put themselves at risk for developing drug-resistant strains of HIV. An HIV-positive person may need to maintain a complicated treatment regimen for many years or for the rest of his or her life.

Helping HIV Medications Work Better

People are better able to take their medications as prescribed if they limit their alcohol intake. People who are working and leading active lives also need to plan ahead to be sure they make time to take their medications exactly as prescribed. Taking each medication correctly every time and every day helps the body fight HIV more effectively.

Preventing Transmission from Mother to Infant

Recent research suggests that women with higher viral loads are more likely to bear a child with the virus. Pregnant women who are living with HIV can reduce the risk of transmission to the fetus by taking zidovudine (also called ZDV or AZT) during pregnancy.  Because HIV can be transmitted through breast milk, the baby of an HIV-positive mother should not be breast-fed. No medications are currently available that prevent the transmission of HIV during breast-feeding.

Nevirapine is another drug currently being studied, and preliminary results indicate it may be even more effective than zidovudine. Because nevirapine is active in the body for a long time, one dose given at the onset of labor combined with one dose given to the infant within 3 days after birth significantly reduced the risk of mother-infant transmission in clinical trials in Uganda.

The low cost of nevirapine (about $4 per treatment) and the short treatment course give nevirapine the potential for widespread use because it removes the cost barriers many developing regions of the world face in terms of providing health care.

Opportunistic Infections

Depending on the CD4 count, an individual infected with HIV may be at increased risk for developing other diseases due to a weakened immune system. These diseases are called "opportunistic infections" because having a weakened immune system gives these infections a greater opportunity to develop. Some possible opportunistic infections include tuberculosis, pneumonia, cytomegalovirus (CMV), toxoplasmosis and cryptosporidiosis.

HIV and Tuberculosis

Because HIV infection severely weakens the immune system, people dually infected with HIV and TB have a much greater risk of developing active TB disease and becoming infectious compared to people not infected with HIV. In fact, over the last five years, 33% of the increase in reported TB cases worldwide is due to HIV/AIDS.

• In the United States, people infected with both HIV and TB have a 100% greater risk of developing active TB disease compared to people not infected with HIV.

• HIV-infected people are at increased risk of progressing to active TB immediately after infection with TB. Active TB may also adversely affect the clinical course of HIV disease itself.

• People infected with HIV and living with AIDS are at greater risk for developing multi-drug resistant TB (MDR TB). MDR TB is extremely difficult to treat and can be fatal.

Everyone infected with HIV should be tested for TB. HIV-positive people infected with TB should complete the full course of a TB prevention drug therapy to reduce their chances of developing active TB. For those with active TB, Directly Observed Treatment (DOT) is an inexpensive, highly effective treatment. Early recognition and treatment of persons with active TB are critically important to prevent further TB transmission.

Anemia

Anemia is an abnormally low level of red blood cells and is a common complication of HIV/AIDS and its treatments. As many as 80 percent of people living with HIV will develop anemia during the course of their disease, and recent studies indicate that anemia is associated with an increased risk of death.

Anemia can be caused by the virus itself or by certain HIV/AIDS treatments that suppress the bone marrow, among other factors. It can be diagnosed by a routine red blood cell count to check hemoglobin levels. Symptoms include fatigue, heart palpitations, shortness of breath, dizziness, pale skin color and a tendency to feel cold.

There are a variety of treatments available, including medications that can stimulate bone marrow to produce red blood cells and increase hemoglobin levels. Patients should discuss treatment options with their physician.

Clinical Trials

The search goes on for more effective and less complicated treatment regimens. For information about drugs undergoing clinical trials, contact the AIDS Clinical Trials Information Service at 800-874-2572.  Information is available in both English and Spanish.

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