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HIV Treatment
Part of A Guide to HIV Drug Resistance

December 2009

Successful HIV treatment usually consists of at least three drugs from two different "classes," or types, of medications. Each class works differently, so that an HIV mutation that makes the virus resistant to one class won't make it resistant to another class.

There are now six classes of drugs that stop HIV from multiplying: NNRTIs, NRTIs, protease inhibitors, integrase inhibitors, fusion inhibitors and CCR5 inhibitors. What makes today's HIV treatment so effective is that it is more powerful than ever before, with fewer side effects.

Current treatment combinations can just about stop HIV's ability to reproduce.

How will you know your HIV is under control? If your medications work well, within about two weeks after starting your first treatment regimen, the amount of HIV in your blood -- your "viral load" -- will decrease dramatically. Within two to six months, you'll probably be told that your HIV is "undetectable." Undetectable simply means that even though you are still HIV positive and can transmit HIV to others, your viral load is now so low that current viral load tests aren't sensitive enough to detect the HIV in your blood. It's sort of like a needle in a haystack -- it's there, but hard to find. HIV can't be totally eliminated because it enters the genetic structure of many cells in your body, including "reservoirs," such as your lymph nodes and spinal fluid, where HIV medications may have a hard time reaching.

The great thing about being undetectable is that it signifies that your HIV is now under control. The number of CD4 cells in your body can begin to grow again and your immune system can recover and do its job. With more CD4 cells, the chance of developing a host of nasty infections and illnesses is reduced. As long as you keep taking all your medications on time, your chances of remaining undetectable are excellent. In addition, with HIV's reduced ability to multiply, there are fewer opportunities for HIV mutations to be made. Of course, if you're on your third, fourth or fifth regimen, and have many drug-resistant mutations, reaching an undetectable viral load is sometimes difficult, if not impossible. Fortunately, many recent studies show there's a benefit to keeping your viral load as low as you can, even if it's detectable. A low, stable viral load can still allow you to increase your CD4 count and reduce the chances you'll become ill.



When you start HIV treatment, your HIV meds will dramatically lower the amount of HIV in your body -- provided you take all your meds on time and your HIV isn't already drug resistant. Some HIV always survives, though, including some mutations.
When you start HIV treatment, your HIV meds will dramatically lower the amount of HIV in your body -- provided you take all your meds on time and your HIV isn't already drug resistant. Some HIV always survives, though, including some mutations.


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