The treatment of an HIV infection has changed completely over the past 15 years. In 1996 there was a revolutionary improvement in the treatment options.
With the introduction of a new group of substances (protease inhibitors) and the simultaneous combined administration of at least three substances (combination therapy, also ART/antiretroviral therapy) a lasting therapeutic success could be achieved. The life expectancy of HIV-positive people is therefore almost normal in countries where this therapy is available.
In the first years after the introduction of antiretroviral therapy (ART) in the mid-1990s, the lack of alternatives sometimes meant that serious side effects and a high number of tablets had to be accepted. In the meantime, however, more than two dozen different drugs have been approved and are in use.
From this selection, the doctor can select the substances best suited to the patient. He will not only consider possible side effects, but also his personal daily routine, such as sleeping and eating habits, possible already existing resistances or pre-existing conditions. As a rule, the patient swallows a few tablets once or twice a day - three or four times a day, often more than 20 tablets, are fortunately a thing of the past.
Today, we can choose from 5 different substance groups, all of which block virus replication in different ways. The basis for almost every antiretroviral therapy is still the oldest substance in use, the nucleoside reverse transcriptase inhibitor (NRTI), which prevents the "reverse transcription" of the "viral language" (RNA) into the human "hereditary language" (DNA). In order to keep the number of tablets as low as possible, two of these substances are usually administered in the form of a combination tablet.
In addition, a third substance belongs to the group of non-nucleoside reverse transcriptase inhibitors (similar to the NRTI), protease inhibitors (block the protein maturation of HIV), integrase inhibitors (prevent the integration of HIV into the nucleus of the human cell) or CCR5 blockers (impede the docking of HIV to the human cell). Modern antiretroviral therapy today usually consists of only 1 to a maximum of 5 tablets per day.
The most important first step after the diagnosis is to accept the HIV infection. For many people a world collapses in the first moment.
One should be aware, however, that there are much more dangerous diseases that reduce life expectancy. In this phase, the support of an experienced psychologist is very helpful in addition to the support of good friends. From a medical point of view, not much will really change as a rule.
The immune system is usually not restricted in this period, which means that there is no increased risk of infection with infectious diseases. Only regular laboratory checks of the immune system (CD4 helper cells) and the virus concentration (viral load) every 3 months are necessary.
As mentioned above, not all HIV infections are treated equally. The European AIDS Society recommends starting antiretroviral therapy in 3 cases:
From a legal point of view, the obligation to inform other people about HIV infection exists only in relation to the respective (sexual) partner. Often it is also very supportive to initiate a very close person, such as close friends or family members. Employers or colleagues do not need to be informed.
Doctors only need to be informed insofar as it is necessary for the respective diagnosis and therapy (clarification or treatment of special illnesses related to HIV infection) or for their own protection against infection (contact with blood, dental treatment, surgical interventions).
No! HIV infection is still an incurable infectious disease that leads to death if left untreated. For this reason, a timely therapy is life-saving, but this requires a timely diagnosis. For this reason every person who has a potential risk of HIV infection should regularly undergo an HIV test!
Written by Mark Riegel, MD
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