Treatment of HIV infection

HIV/AIDS Dictionary

HIV- Human Immune deficiency Virus
AIDS- Acquired Immune deficiency Syndrome
Antibodies- Cells produced by the body to fight infection.
CD4- Fighter cells/ immune cells
Antiretrovirals- Medication to slow the progress of the HI virus
STI- Sexually Transmitted Infection
Kaposi Sarcoma- Aids related cancer
Lesions- Injury to the living tissue of the body, usually as a result of disease or injury
ADC- Aids dementia complex
Adherence- Taking medication exactly as prescribed
Viral evolution- The change in the make-up of the virus. Influences ART
ART- Antiretroviral therapy
ARV- Antiretrovirals
VCT- Voluntary counseling and testing

Telephone numbers
to remember:

National AIDS Helpline: 0800 012 322
HIV Health Workers Hotline: 0800 212 506
AIDS Consortium: 011-403 0265
AIDS Law Project ALP: 011- 717 8600
National Association of people living with AIDS(NAPWA): 011-872 0975

Treatment Action Campaign (TAC):
Cape Town: 021-364-5489
Johannesburg: 011-403-2293
KZN: 031-304-3673
Eastern Cape: 043-760-0050

ARV (Anti Retro Viral) treatment

HIV is not a death sentence and neither does it mean that you have AIDS. HIV is an infection which affects your immune system but with proper medication and care including nutrition and education HIV can be managed allowing the patient to live life in much the same manner as before the HIV infection.

The drugs used to treat HIV positive patients are called antiretrovirals. The cost of ARVs is high but governments around the world are implementing a plan which will make ARV treatment accessible to all, including those in poverty stricken areas. The South African government has implemented an ARV roll out program, announcing in 2011 that any HIV positive patient with a CD4 count of 350 and below will have access to ARV therapy.

Adherence

In order for an HIV positive patient to improve and maintain their health and avoid the development of drug resistance it is critical that they adhere to the ARV program as prescribed by their health care worker.

The success of antiretroviral therapy depends on adherence, this means tablets need to be taken as prescribed. Missing three or more doses a months reduces the efficacy of the treatment and also opens the patient up to viral resistance and ultimately virological failure. This means that the ARV drugs are no longer effective in resisting infections or maintaining the immune system.

It is interesting to note that certain treatment plans require a fridge for storing of the drugs and others don't. This means that rural communities where electricity is not available will still be able to adhere to the treatment plan.

Possible side effects of ARV therapy

Patients in whom HIV has advanced to a stage where the CD4 count is below 50cells per mm3 will experience a reaction to the ARV treatment similar to the symptoms of a new HIV infection including nausea, sweats, fever, shortness of breath etc.
Immune reconstitution illnesses occur when an improving immune function identifies a previously unnoticed opportunistic infection. An example of this might be TB.

Should these infections occur the patient should be referred to an experienced HIV clinician.

Is there a cure for HIV?

There is no cure for the HIV virus, however modern medicine has made it possible for HIV patients to live a longer live because the anti-retroviral treatment prevents the virus from spreading through the body allowing the patient to live a normal life without the various infections and tumors that plagues HIV positive people.

This however does not overshadow any hope of a cure, in fact giant leaps are being made in that direction on a regular basis. As treatment of patients improves, so too does the likelihood of a cure for HIV/Aids. Where people were taking upto 20 pills or more a day they are now down to three and living longer and heathier lives than before they became infected.

News about a cure for HIV

Scientists on the brink of a cure. This is a common headline, but that 'brink' is wide. Once a cure is actually found it will be a number of years before it becomes available. What will be the cost when it does, and will it become freely available?

Maybe it's just wishful thinking or possibly it is the hope for a cure that drives people to believe that a cure is imminent or that a cure for AIDS has been found. This kind of news report and rumour leads to false hope and dissapointment, but more damaging than this is that it leads to a change in behaviour for the worse.

As it stands, there are sectors in hard hit communities, especially amongst the younger generation where 'AIDS is not a death sentence' has been taken to it's literal extreme with the assistance of ARV's. The mindset is one of ARV's will allow me to live my life even if I contract HIV, which leads to changes in behaviour and an escalation in the numbers of new infections.

That there is no cure for AIDS is one of the first things one learns when faced with AIDS and HIV prevention. If rumours persist that there is a cure, less care will be taken and and the infection rate will increase.

While breakthroughs in the search for a cure are frequent, the answer has yet to be found.

Prevention at any case is always better than cure.

What is a functional cure?

There have been instances where a patient who is HIV positive displays an undetectable level of the virus in their blood. This is as a result of HIV treatment begun almost immediately; as in the case of the baby who was born HIV positive and placed on a regimen of ARVs when she was two days old.
After 18months of ARV therapy the baby's mother stopped administering the medication; the child was found to have no detectable virus. This is known as a functional cure. Five months later the situation remains the same, which if nothing else is a ray of hope on a final cure.

As with TB simply stopping medication can have far reaching implications the least of which is resistance to the medication should the virus become detectable again.

Research findings in December 2013

The search for a cure or a vaccine against HIV is ongoing, worldwide. Progress is constantly being made in slowing down the effects of the virus and reducing viral loads in patients to virtually undetectable.

The latest breakthrough in the search for an HIV cure comes in the form of radioimmunotherapy. Blood was taken from patients who were receiving highly active anti-retroviral therapy and submitted to the radioimmunotherapy. It was discovered that cells treat with the highly active ARV regimen could be singled out and destroyed, reducing the infection to almost undetectable levels.

The blood brain barrier can not be penetrated by the current range of ARV's however the radioimmunotherapy is able to pass the barrier and kill the HIV infected cells without damaging the blood-brain barrier.

Only time will tell whether this is indeed an effective measure, but scientists remain actively focused on finding a cure as every breakthrough, no matter how small, is a step closer.

A Bee virus may hold a solution

An interesting observation has been made by scientists who are looking for the reason behind colony collapse disorder in bees. A virus which affects plants such as tobacco and soy has mutated and is being transferred to bees through pollination activities and through other parasites which affect bees such as the varroa mite.

This virus is able to mutate and and adapt much like HIV and swine flu. If this virus can be broken down into a simpler form or researchers can understand how it mutates and find a way to prevent it there may indeed be something new for HIV researchers to work with.

A positive outcome from HIV

Standard media report in June 2013 that after fighting leukemia for two years, and not well enough to undergo a bone marrow transplants, the parents of a 6year old girl in Philidelphia USA gave doctors the go-ahead to use a radical therapy known as CTL019.

CTL019 involves using a disabled form of HIV to carry cancer fighting genes into a patients T-cells. The thinking behind this therapy is that it would be possible to reprogramme the immune system to recognise and kill the cancerous cells.

After a 3 month and a 6 month check-up, physicians announced that the girl was cancer free.

Because HIV is destructive by nature and is responsible for millions of deaths, it is decidedly gratifying that HIV quite literally had something positive to contribute.

How far has the work towards devloping a vaccine or cure for HIV come?

With nearly a third of the population in South Africa diagnosed as HIV positive, the drive towards finding a cure or a vaccine is in high gear and government is paying close attention to any developments which will bring the world a step closer to ending a disease which has ravaged the country.

Latest Developments in the search for an HIV cure

It has been discovered that certain people are able to produce the anti-bodies which can combat the virus, however these anti-bodies are not in great enough quantities to be effective or because HIV is a mutating strain, one particular antibody is not effective.

The next step

A way needs to be found where-in a vaccine is able to engage with the B-cells thereby strengthening the defence sufficiently to act as a vaccination against HIV.
Individuals whose bodies produce the right type of cellular structure for this purpose have been identified, however testing may take a number of years before any of the outcomes can be put to use.

Multiple fields of research

While the aim: to find a cure or a vaccine for HIV/Aids remains the same the fields of research are varied. The notion of tackling a problem from all angles comes in to play and this will also encourage the sharing of information.

 

last updated on 2July 2014