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Women & HIV/AIDS Treatment

January 25, 2008

HIV medicines are giving women longer, healthier futures and new strength. While there's no cure for HIV, the treatments today allow women to live longer. Making sense of all your treatment options can be hard. By getting the facts, you can decide the best way for you to manage your illness.


You Have Options

Related Information

FDA: Drugs used in the treatment of HIV

FDA: Drugs used in the treatment of pediatric HIV infection

FDA: Generic drugs used in the treatment of HIV infection

If you test positive for HIV, find a doctor you can trust who treats HIV positive women. If you need help finding a one, call the CDC National AIDS hotline at 800-CDC-INFO (232-4636). This hotline will either point you to a specific doctor or to resources in your area where you can get health care, like a clinic. Your doctor will talk to you about your health. You also will get a physical exam. If you found out about your positive result over the phone from a counselor at a mail-in testing company, follow up with a doctor to talk about your result.

You will have tests to figure out if and when you should start treatment. Some tests may include:


Treatment Will Slow Down the Disease

There is no cure for HIV/AIDS. But there are medicines that slow down the disease. The FDA has approved a number of drugs for treating HIV. Because each HIV drug can't work by itself, patients must take a combination of three or more drugs. When this combination of drugs is taken, it's called "highly active antiretroviral therapy" or HAART. Sometimes, it is also called a "cocktail" or "cocktail therapy." When taken properly, HAART treatment helps people with HIV live longer and have fewer infections or other problems related to their HIV. The drugs work by lowering the amount of HIV in the blood and improving your body’s ability to fight infections.

Many medications and other drugs and substances can interact with HIV medicines. These interactions can hurt you or make the HIV medicines weaker. So you should tell your doctor if you are using any other prescribed medications. Also, tell your doctor if you are using any recreational drugs, alcohol, herbal remedies, or over-the-counter medicines. Make sure to tell your doctor if you are taking birth control pills. Some HIV drugs can make the birth control pill not work as well. Also, tell your doctor if you are pregnant to figure out the best treatment for you and your baby.

There are four classes of drugs used to treat HIV. The names of HIV drugs can be confusing. Many HIV drugs have both a brand name and a generic name. Some also go by a shortened name. For example, Retrovir® is the brand name of zidovudine (the generic name), and also goes by "AZT" or "ZDV". Also some drugs now are combined into a single pill. For example, Combivir® includes both lamivudine and zidovudine in a single pill. Your doctor will help you decide which medicines should be included in your treatment.

The four classes, along with the drugs that have been FDA approved as of March 2007, are:

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) (also called "nukes") prevent HIV from making copies of itself. Usually, you take two drugs from this class as part of your HAART. These can be combined in one pill or taken separately.

Brand Name Generic Name Other Names
Combivir® combination of:
lamivudine
zidovudine

la-MY-vyoo-deen
zye-DOE-vyoo-deen
ZDV/3TC
Emtriva® emtricitabine em-trye-SYE-ta-been FTC
Epivir® lamivudine la-MY-vyoo-deen 3TC
Epzicom® combination of:
abacavir
lamivudine

a-BAK-ah-veer
la-MY-vyoo-deen
ABC/3TC
HIVID® zalcitabine zal-SITE-ah-been ddC
Retrovir® zidovudine zye-DOE-vyoo-deen AZT, ZDV
Trizivir® combination of:
abacavir
lamivudine
zidovudine

a-BAK-ah-veer
la-MY-vyoo-deen
zye-DOE-vyoo-deen
ABC/3TC/ZDV
Truvada® combination of:
tenofovir
emtricitabine

te-NOE-foe-veer
em-trye-SYE-ta-been
TDF/FTC
Videx® didanosine dye-DAN-oh-seen ddl
Videx EC® enteric coated
didanosine

dye-DAN-oh-seen
ddl EC
Viread® tenofovir te-NOE-foe-veer TDF
Zerit® stavudine STAV-yoo-deen d4T
Ziagen® abacavir a-BAK-ah-veer ABC


Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (also called "non-nukes") prevent HIV from making copies of itself. You usually take one from this class or one or two from the protease inhibitor class.

Brand Name Generic Name Other Names
Rescriptor® delavirdine de-la-VEER-deen DLV
Sustiva® efavirenz eh-FAV-er-enz EFV
Viramune® nevirapine neh-VYE-ra-peen NVP

Protease Inhibitors (PIs) block a protein that HIV makes to stop HIV from making copies of itself and infecting healthy cells. You usually take one or two from this class or one from the NNRTIs class.

Brand Name Generic Name Other Names
Agenerase® amprenavir am-PREN-ah-veer APV
Aptivus® tipranavir tip-RAN-ah-veer TPV
Crixivan® indinavir in-DIN-ah-veer IDV
Invirase® saquinavir sah-KWIN-ah-veer SQV
Kaletra® combination of:
lopinavir
ritonavir

low-PIN-ah-veer
ri-TOE-na-veer
LPV/RTV
Lexiva® fosamprenavir FOS-am-PREN-ah-veer FOS-APV
Norvir® ritonavir ri-TOE-na-veer RTV
Prezista® darunavir dar-UE-na-veer DRV
Reyataz® atazanavir at-a-ZAN-ah-veer ATV
Viracept® nelfinavir nel-FIN-ah-veer NFV


Fusion Inhibitors work outside of the cell to keep HIV from infecting healthy CD4 cells.

Brand Name Generic Name Other Names
Fuzeon® enfuvirtide en-FYOO-vir-tide T-20


Multi-class Combination Products combine drugs from more than one class into a single product.

Brand Name Generic Name Other Names
Atripla® combinarion of:
efavirenz
emtricitabine
tenofovir

ef-FAH-ver-enz
em-trye-SYE-tah-been
te-NOE-foe-veer
 

Information From the Food and Drug Administration (FDA)

  • In July 2006, the FDA announced approval of Atripla® tablets, the first one-pill, once-a-day product to treat HIV/AIDS. Atripla® contains a fixed-dose combination of three widely used antiretroviral drugs in a single tablet. It is taken once a day, either alone or in combination with other antiretroviral products for the treatment of HIV-1 infection in adults. Atripla® combines the active ingredients of Sustiva® (efavirenz), Emtriva® (emtricitabine), and Viread® (tenofovir disoproxil fumarate). Atripla® was approved in less than three months under the FDA's fast track program.
  • In June 2006, the FDA approved Prezista® (darunavir), a new drug for adults with HIV who do not respond to other antiretroviral drugs. Prezista®, a protease inhibitor, is approved to be taken with a low dose of ritonavir and other active anti-HIV agents. Ritonavir slows the breakdown of Prezista® in the body. Prevista® also was approved under the FDA’s fast track program.


For treatment guidelines for pregnant women with HIV, see the AIDS and Pregnancy section.


When to Start Treatment

Talk to your doctor about when to start treatment. The time to start treatment is different for everyone because there are many factors to consider, such as:

There are still a number of things about treatment of HIV that we do not know. This is particularly true for women. Research and clinical trials of what medicines to use and when to start are seeking to answer those questions.

When you begin to discuss treatment options with your doctor, ask about clinical trials. Your doctor can tell you if there are any that would be open to you and how to enroll if you want to participate.


HIV/AIDS Drugs Cause Side Effects

Despite the beneficial effects of HAART, you can get side effects from the drugs. Some are serious. Others are bothersome, but go away with time. These are some side effects:

HIV treatment can be hard because of side effects. Before you start taking HIV drugs, talk to your doctor about side effects you may have, ways to feel better, if/when they will go away, and how long they'll last. Even though you have side effects from the drugs, it's important to take your medicines exactly how and when you're told to and to let your doctor know about your symptoms.

Side Effects are Different in Women

You may find that the side effects you're having from the medicines are not the same as other people, especially if the other people are men. Women take the same doses of HIV drugs as men, but have smaller body sizes, higher body fat, and different hormones. Some researchers think these factors affect how women respond to the medicines and believe they cause different side effects in women. For example, Norvir® causes more nausea and vomiting in women but less diarrhea than in men. Some studies show that women are more likely to get rashes, fat build-up, and problems with the pancreas and liver. But before treatment doses change, more clinical trials need to be done that include women.


Stick to Your Treatment

HIV drugs can be hard to take. You may need to take a lot of them, and they can cause side effects that are hard to manage. But it's so important that you take all of them as your doctor tells you to. Missing medications can result in the development of drug resistance. This is when the virus is able to "ignore" the medications, and so the medicines do not work as well in fighting the virus or at all. Even people who take their medicines most of the time, but not all of the time, face a high risk of drug resistance. When resistance develops, you will need to change to a new set of medications. The chance of success with your new HAART will not be as high as with the first HAART. You also might get new side effects that you must get used to. Here are some ways to stick to your treatment:


How to Know if Treatment is Working

There are ways to know if your treatment is working. Your doctor will consider these factors:

Even if the treatment is working and the amount of HIV in your blood is so low that that the tests can't find it, you still have HIV or AIDS. You can still give HIV to other people. Keep using condoms, and don't share drug needles. And remember, the HIV will start to increase in your blood again if you stop taking your medicines.


Taking a Drug Holiday

If you take medicines for HIV/AIDS, you may feel like the drugs are running your life. It's tough to take all of the medicines when you're supposed to, some with food, some not. The medicines' side effects can make you long for a break from treatment. Researchers have found that it is not a good idea to stop treatment once started. Stopping can result in you getting sicker and having more side effects from the medications.

The National Institute of Allergy and Infectious Diseases (NIAID) conducted a study of people who had drug-resistant HIV (a type of HIV that does not get better with medicines) and detectable virus in their blood to find out if breaks in their treatments would help them. Unfortunately, it didn't work for this group. Strategy for Management of Antiretroviral Therapy (SMART) is another government-funded study that looked into the possible role of drug holidays in HIV treatment. This study found that even in patients who had not been on HIV medications before, taking planned holidays from drugs was dangerous and resulted in higher risks of getting sick or dying and having more problems with medications. At this time, planned drug holidays are not advised as part of routine care.

Treatment was reviewed by Lisa Hirschhorn, M.D., M.P.H., Senior Clinical Consultant HIV/AIDS, JSI Research and Training.


Additional Information on Treatment

Publications

  1. Drugs Used in the Treatment of HIV Infection
    This publication lists anti-retroviral drugs by brand name and provides their generic name, manufacturer, and FDA approval date.
  2. Drugs Used to Treat Complications of HIV/AIDS
    This publication lists the brand names, generic names, uses, manufacturers and approval dates for various drugs employed to treat complications of HIV/AIDS.
  3. Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents
    This report from the U.S. Department of Health and Human Services gives the treatment guidelines for adult and adolescent HIV patients. It includes information on when to start antiretroviral treatment, what medications to start with, what medications not to use, and how to manage treatment.
  4. HIV and Its Treatment: What You Should Know
    This publication provides basic information for people recently diagnosed with HIV and also gives information on when to start treatment. Treatment during pregnancy is also discussed as well as what to expect during treatment.
  5. Treatment of HIV Infection
    This fact sheet gives an overview of the drugs that have been developed and approved for treating individuals with HIV. It also briefly covers the side effects of these drugs and what research is being done in the field.
  6. AIDSinfo Drug Database
    The AIDSinfo Drug Database provides fact sheets on approved and investigational HIV/AIDS related drugs that describe the drug's use, pharmacology, side effects, and other information.
  7. Anti-HIV Therapy Strategies (Copyright © Project Inform)
    This publication reviews the new anti-HIV drugs currently, or soon to be, in studies. It also explains how the drug is different or similar to those already used in the treatment of HIV.
  8. Dealing with Drug Side Effects (Copyright © Project Inform)
    This publication gives information on how to cope with the side effects of anti-HIV drugs. Its topics cover fatigue, anemia, headache, nausea and vomiting, diarrhea, weight loss, dry mouth, rash, peripheral neuropathy, period problems, and hair loss.
  9. Herbs, Supplements, and HIV (Copyright © Project Inform)
    This publication discusses some of the complications of using herbal supplements to manage HIV therapy side effects.
  10. Making Decisions About Therapies (Copyright © Project Inform)
    This publication gives information on what to consider before starting HIV therapy. It discusses how to choose a doctor, why you should learn about all the diffferent treatment options, and when to start therapy.
  11. Side Effects (Copyright © AIDS InfoNet)
    This publication describes some of the most common side effects that patients receiving HIV drugs experience. It provides tips for how to deal with the side effects.
  12. Strategies for When to Start Anti-HIV Therapy (Copyright © Project Inform)
    This publication reviews what you should consider before starting HIV therapy. It includes basic information on drug resistance testing and the different therapy options.

Organizations

  1. AIDSInfo
  2. CDC National Prevention Information Network
  3. Division of Acquired Immunodeficiency Syndrome (DAIDS), NIAID, NIH, HHS
  4. Office of Special Health Issues, FDA, OPHS, HHS
  5. AIDS InfoNet
  6. AIDS.ORG, Inc.
  7. San Francisco AIDS Foundation
  8. Women Alive
  9. Women Organized to Respond to Life-threatening Diseases (WORLD)




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