Treatment of HIV / AIDS - Everything You Need To Know

HIV can now be treated with a range of medicines. The so-called antiretroviral therapy (ART) is a combination of several active substances that contain the multiplication of the pathogen. The outbreak of diseases caused by the virus's weakening of the immune system can thus be avoided or delayed.

1. The primary goal of HIV treatment is to suppress viral replication.
2. Standard therapy is currently the combined administration of at least two active substances.
3. An immediate start of medication is recommended.
4. For good treatment success, the drugs must be taken for a lifetime and the adherence to therapy must also be high.
5. If there is a probability of infection, immediate drug prevention (post-exposure prophylaxis) makes sense.
6. Under effective therapy, infection via sexual contact is unlikely.
7. Today's therapies allow an almost normal life expectancy if the HIV infection is detected early.

What therapy options are available?

In 1987, the first drug against HIV was approved - a decisive breakthrough in the then almost hopeless fight against the rapidly spreading disease. There are now more than 30 drugs that are used to treat the infectious disease. Nevertheless, a cure in the sense that the virus is completely removed from the body is still not possible.

The reason for this is that all drugs available to date only prevent the virus from multiplying. However, the drugs have no effect on genetic material that the pathogen has "hidden" in human cells and that is in a kind of resting phase there. As soon as the substances are discontinued, the dormant genetic information becomes active again and the virus can spread again.

The aim of the current HIV treatment is therefore to suppress the multiplication of the viruses. If viruses are hardly produced any more, the immune system is relieved and new T-helper cells, so-called CD4 lymphocytes, can form. At the same time, the viral load decreases, which in turn reduces the risk of infection.

Standard therapy is currently the combined administration of at least two active substances. The substances used in this highly active antiretroviral therapy (HAART) partly interfere at different points in the HIV propagation cycle, which increases the efficiency of the therapy.

In order to determine the optimal drug combination for each patient, regular check-ups are required to determine the viral load and CD4 lymphocyte count in the body of the patient. Modern media drugs, however, are generally well tolerated. However, if side effects of antiretroviral therapy - such as nausea, vomiting and diarrhoea - occur, these can be recorded in the controls and, if necessary, treated with additional medication. Many different therapy options/medications are already available today in order to be able to select the optimal therapy for the patient.

Start of therapy

Today, most HIV therapists and medical guidelines recommend an immediate start of therapy regardless of laboratory values. At the very latest when the number of CD4 cells falls below the 350 cells/µl mark, HIV therapy must be initiated.

According to the guidelines, HIV patients should be cared for and treated by doctors and institutions specialising in HIV. Nowadays there are outpatient clinics and ordinances in many larger cities.

Therapy adherence

Thanks to modern medicines, HIV-infected patients can reach a normal age. Even if symptoms have already occurred, they can regress under therapy.

However, it is indispensable for the success of treatment that those affected take their medication consistently and according to the doctor's instructions, and for a lifetime. This is the only way to ensure that the active substances are always present in sufficiently high concentrations in the blood.

If the active substance level drops due to irregular intake or unauthorised therapy breaks, this can lead to a strong increase in the number of viruses and thus to a relapse of the disease. On the other hand the development of resistances is promoted in this way. This means that the virus develops increasing resistance to drugs used in HIV therapy. In this case, the drug is only partially effective or, in the worst case, not effective at all.

What can be done to prevent HIV infection?

There are not many diseases where prevention is as important and easy to manage as HIV infection. The key is to protect yourself and others as much as possible from infection.

Safer sex

The most common transmission route is contact with body fluids containing viruses, such as sperm, blood or vaginal secretions. It is therefore one of the most important precautionary measures that condoms, femidoms or dental dams (oral sex) are used during sex. This applies to both homosexual and heterosexual sexual contacts.

HIV pre-exposure prophylaxis

HIV drugs can not only reduce a possible risk after (PEP = post-exposure prophylaxis) but also before (PreP = pre-exposure prophylaxis) taking it. However, only one drug has been approved for this use so far.

This drug was actually developed for the treatment of HIV infection and has been successfully used for this purpose for years. Due to the many years of use, the patent protection for this drug has expired.

This means that other pharmaceutical companies may legally "reproduce" this drug. Drug copies ("generics") are successfully used for cost reduction with many substances and are practically equivalent to the original preparation in terms of effect and side effects.

Since the development costs are eliminated, generic companies can offer their products at a much lower price. This is also the case with PrEP: while the original drug is affordable for practically no one with almost $1,000 for a monthly package, generics are available for less than a tenth, namely for $60.

Treatment of HIV-positive patients

It has been established for several years that treated HIV patients whose HIV virus load cannot be detected in the blood for at least six months and who have no other sexually transmitted diseases (syphilis, gonorrhea, chlamydia) are practically no longer infectious. This prevention strategy is known internationally as "Treatment as Prevention".

Clean syringes

An HIV high-risk group is an intravenous (i.v.) substance-dependent group, i.e. addicts who inject substances directly into the vein using syringes. Syringes, needles and other accessories should only be used once and should never be shared with other substance users. Clean syringes and needles are given to drug addicts at various counselling centres.

Gloves for medical staff

Doctors and nursing staff should use gloves if there is a risk of coming into contact with patients' body fluids. However, there is no danger in the normal handling of patients - such as shaking hands.

What can you do if you fear infection?

If there is a high probability that an infection has occurred - for example after unprotected sexual intercourse with an HIV-positive sexual partner or if a nurse has injured herself on a contaminated instrument - post-exposure prophylaxis (PEP) can be useful. This is usually a four-week therapy with HIV drugs to prevent the virus from settling in the body and leading to a chronic infection.

This HIV-PEP should ideally be started two, but at the most 24 hours after the possible infection. Studies have shown that post-exposure prophylaxis for injuries with contaminated instruments significantly reduces the risk of infection. Individual case reports show a similar effect after risky sexual contacts. Nevertheless, nobody should rely on this measure, because even with optimal implementation an infection cannot be prevented with certainty. The doctor and patient should decide together whether there is a relevant risk and whether a PEP should be carried out.