HIV Treatment -- Questions & Answers

What kinds of medicine are used to treat HIV?
Before 1996 there weren't a lot of options for HIV positive people. Usually it was only a matter of trying to keep opportunistic infections under control. AZT was the drug of choice back then. Developed in the 1960s it interferes with how HIV reproduces. Studies have shown people who are HIV positive and took AZT tended to develop full blown AIDS later and survived longer. However AZT was toxic and many people suffered directly from this toxicity.

In the mid 1990s additional drugs were introduced. Due to the fact drugs are coming in and off of the market so quickly I won't go into naming them specifically but group them by family or type of drugs.

Classes of drugs include those called NRTI (single combination nucleoside reverse transcriptase inhibitors) and Multiple NRTIs. NRTIs work by inserting a molecule in the chain that builds the enzyme reverse transcriptase so it will not work.

Non-NRTI drugs these drugs work by attaching themselves to reverse transcriptase to keep it from making the RNA of HIV into DNA.

In addition Protease Inhibitors target another enzyme of the HIV virus called protease. The various kind of drugs in these classes are used in combination to prevent the HIV from adapting to the one particular drug and prevent it from working correctly to destroy the virus.

How do these drugs work?
HIV treatments to do not eliminate the virus from the body but they stop or at least slow down the reproduction of the HIV virus. The various drugs work in different ways depending on what drug is used and where in the reproduction cycle it can act.

For example reverse transcriptase inhibitors block the enzyme that replicates the HIV genetic material. In contrast Protease Inhibitors block the enzyme the plays a role in repackaging the new virus particles.

What are combination therapies?
This means the use of multiple kinds of drugs to target different points of the HIV virus. By attacking different parts of the virus with different drugs, it slows down the reproduction and prevents the virus from becoming resistant to that drug. It is common to use three different kinds of drugs, but some therapies use two and some use as many as six different drugs.

My friend has HIV and mentioned HAART, what's that?
HAART stands for:

Highly
Active
Anti-
Retroviral
Therapy

It refers to multiple drug therapies that include use of a Protease Inhibitor. Sometimes referred to as a "cocktail."

Is it true using street drugs with HIV meds can kill you?
Yes, some drugs have been associated with deaths. Even alcohol can cause problems when you're on certain medications.

How do doctors know if the HIV drugs are working?
The goal of the HIV drugs are to slow down the reproduction of the virus. Doctors monitor the amount of HIV genetic material in the blood plasma. When the viral load drops that is good. The drugs are considered successful when the viral load drops to undetectable.

What does it mean when they say you must "strictly adhere to HIV medications?"
The HIV meds require that you take the drugs exactly as prescribed, exactly at the same time each day and never miss a dose. For some people this can mean more than a dozen pills a day, some with food, some without food. So your life becomes scheduling your activities around taking your pills. Science has gotten better and some people are able to get by with one or two pills a day for their HIV medicine.

Why so strict?
Unlike most other disease HIV mutates very rapidly if you miss doses it give the virus a chance to mutate and adapt to the drugs you are taking. What that means is the drugs will not be effective anymore.

What is a drug holiday?
This is when you stop taking all medications. Sometimes this is necessary when the drugs you are taking become ineffective. In some cases you have to wait for the older drugs to clear out of your body before starting new ones. Because the HIV drugs are so toxic some people feel they need a break from the side effects so they stop taking the meds, feeling the side effects are worse than the disease. A drug holiday is generally a bad idea, but as always you have to consult with your doctor on its advisability.

How effective are the HIV drugs?
They are very effective in suppressing replication of HIV activity and extending the lives of those with HIV and AIDS. However a large minority, about 20% of those infected with HIV, do not respond to treatment.

Why do some people not respond?
This is because there are different strains of HIV. The viruses mutates or changes so rapidly it is often able to overcome the meds.

What are side effects of HIV medications?
Common side effects include nausea, vomiting, diarrhea, headaches, sleeping problems and fevers. Side effects can be minimized but some people do not have any side effects, while other have severe side effects, which may prevent them for working.

What is lipodystrophy?
This refers to a change in body fat. This occurs in other diseases beside HIV but is most commonly associated with "The AIDS look." This involves a loss of body fat in the face and the "hump" on the back. (Insert Link)

What are common "scam" treatments for AIDS?
The most common are "Ozone treatments," "blood heating treatments," "herbs" and "parasitic treatments." Presently there is no proof any of these treatments does anything but empty your pockets.

Are we close to a vaccination or cure for AIDS?
Many researchers currently think a single vaccination or cure for AIDS is not possible. Like the flu the HIV virus mutates so quickly it is hard for the body to recognize each mutation. As the flu vaccine must be changed every year, most likely any HIV vaccination would have to be updated from year to year. Researchers are currently focused on trying to make the drugs available to suppress HIV less toxic and enable the person to take only one or two pills per day.

Any other hope for AIDS victims?
Besides new drugs it does appear that even without medicines the HIV virus is becoming less aggressive over time. All viruses get less aggressive over time and HIV appears to be no exception. Remember if a virus kills off all its hosts the virus itself dies out.

And also remember AIDS is nearly a 100% preventable disease and this is often lost on the gay community in a politically correct world.

What can I do to help people with HIV?
The most important thing you can do is to provide support for them. It is very difficult to live with the virus and it wears you down. Helping with the daily activities, pushing them to get exercise is very important. People on HIV medicines often are tired, but need the exercise. Go with them to the gym; make them take walks and things like that. Reminding of them of their schedule of medications and accompanying them to doctor visits. Basically support them and be there for them. This is often hard as almost all HIV infected individuals suffer from depression, so its important to not only help them but set aside time for yourself so you can better help them too.

What is a hospice?
It is an approach for people who are terminally ill and their life expectancy is months or even weeks. Hospices care about "QAULITY" of life rather than quantity, the teach approaches to coping with pain, including spiritual and psychological pain.

Do AIDS victims need nursing home care?
No, about 75% do not require nursing home care. All nursing homes are equipped to provide correct care. It is often advisable to seek out nursing homes that specifically care for AIDS sufferers. Also remember almost all people who have AIDS whether or not they need nursing home care, need people to care for them at their home, on a full or part time basis.

Where are AIDS or HIV support groups?
The Internet is the best place to look. In addition to HIV victims it may be advisable for non-HIV infected people to have access to support groups as dealing or caring for an HIV infected person is often hard too.

What special needs should I as a support person give to an HIV infected friend?
Making sure they eat properly and exercise regularly is the most important thing. Because some HIV drugs are taken with food and some on an empty stomach food becomes very regimented. HIV drugs can cause sleep problems, too much or too little, depending on the drug. People with HIV often need to be "forced" to get a proper amount of exercise and the right amount of food.

My friend has HIV and smokes and drinks is that bad?
Yes, some people with HIV feel well I'm going to die anyway so what if I smoke. Smoking effects the immune system even in healthy non-HIV infected individuals. Smoking can interfere with some HIV drugs. Alcohol can also effect some medications. See your doctor for specific drugs and problems.

Must people with HIV drink bottle water?
Most city water is safe as is well water. However there are some bacteria in water that may exist in such small quantities that a person with a normal immune system will cause no issues, but it may not be safe for people with HIV. Also water treatment systems are not infallible. In the mid 1990s in Milwaukee the water treatment system failed and there was an epidemic of cryptosporidium, which is a parasite that causes severe diarrhea. Because there is no cure, you simply let the disease run it's course making sure you don't get dehydrated. People with HIV can't overcome cyrptosoridium so it may lead to their death. This is why drinking bottle water is recommended. If that is not an option then make sure you boil your tap water for 10 minutes before using.

Why is it recommended that people with HIV not have cats?
Cats can carry a parasite that normally is not an issue for people with normal immune systems. Taxoplasma gondii is common in cat feces. If you insist on having a cat it is recommended to always use gloves and face max when cleaning the cat box. As you probably know by the large number of gay men with cats, the recommendation isn't followed much, but it remains valid.

If I have a cold or flu should I stay away from my friend who has HIV?
Depending on their stage of the illness it's best to avoid contact. If you a primary care giver or friend while you have your cold or flu, and must visit your friend, it best to eliminate physical contact such as hugging for the duration of the cold.

Contrary to popular belief colds and flu are actually spread not by coughs or sneezes but rather by putting your hand to your nose. For instance someone will sneeze and cover his mouth with his hand. That person shakes another person's hand and then touches his nose.

So if you live with an HIV infected person it would be best to minimize contact with him if you have a cold, such as sleeping on the couch.

Can people with HIV get vaccinated?
Usually this is not an issue, reactions to the vaccines are slightly greater but the CDC recommends vaccinations to prevent diseases. Most people with HIV are at lower risk from the side effect of a vaccine than the illness. Always check first, for instance the flu vaccine given thru nose spray is more effective because it uses a live but weakened virus. The flu shot is a dead virus. So in this case a person with HIV should only get the shot.


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