Treatment:![]()
There is currently no vaccine or cure
for HIV or AIDS. The only known methods of prevention are based on
avoiding exposure to the virus or, failing that, an antiretroviral
treatment directly after a highly significant exposure, called
post-exposure prophylaxis (PEP).PEP has a very demanding four week
schedule of dosage. It also has very unpleasant side effects including
diarrhea, malaise, nausea and fatigue.
Current treatment for HIV infection consists of highly active
antiretroviral therapy, or HAART.This has been highly beneficial to many
HIV-infected individuals since its introduction in 1996 when the
protease inhibitor-based HAART initially became available. Current
optimal HAART options consist of combinations (or "cocktails")
consisting of at least three drugs belonging to at least two types, or
"classes," of anti-retroviral agents. Typical regimens consist of two
nucleoside analogue reverse transcriptase inhibitors (NARTIs or NRTIs)
plus either a protease inhibitor or a non-nucleoside reverse
transcriptase inhibitor (NNRTI). Because HIV disease progression in
children is more rapid than in adults, and laboratory parameters are
less predictive of risk for disease progression, particularly for young
infants, treatment recommendations are more aggressive for children than
for adults.In developed countries where HAART is available, doctors
assess the viral load, rapidity in CD4 decline, and patient readiness
while deciding when to recommend initiating treatment.
Abacavir - a nucleoside analog reverse transcriptase inhibitors (NARTIs
or NRTIs)
Atazanavir - a protease inhibitor
HAART allows the stabilisation of the patient’s symptoms and viremia,
but it neither cures the patient of HIV, nor alleviates the symptoms,
and high levels of HIV-1, often HAART resistant, return once treatment
is stopped.Moreover, it would take more than the lifetime of an
individual to be cleared of HIV infection using HAART.Despite this, many
HIV-infected individuals have experienced remarkable improvements in
their general health and quality of life, which has led to the
plummeting of HIV-associated morbidity and mortality. In the absence of
HAART, progression from HIV infection to AIDS occurs at a median of
between nine to ten years and the median survival time after developing
AIDS is only 9.2 months.*7] Still, for some patients - and in many
clinical cohorts this may be more than fifty percent of patients - HAART
achieves far less than optimal results. This is due to a variety of
reasons such as medication intolerance/side effects, prior ineffective
antiretroviral therapy and infection with a drug-resistant strain of
HIV. However, non-adherence and non-persistence with antiretroviral
therapy is the major reason most individuals fail to get any benefit
from and develop resistance to HAART.The reasons for non-adherence and
non-persistence with HAART are varied and overlapping. Major
psychosocial issues, such as poor access to medical care, inadequate
social supports, psychiatric disease and drug abuse contribute to
non-adherence. The complexity of these HAART regimens, whether due to
pill number, dosing frequency, meal restrictions or other issues along
with side effects that create intentional non-adherence also has a
weighty impact.The side effects include lipodystrophy, dyslipidaemia,
insulin resistance, an increase in cardiovascular risks and birth
defects.
Anti-retroviral drugs are expensive, and the majority of the world's
infected individuals do not have access to medications and treatments
for HIV and AIDS.Research to improve current treatments includes
decreasing side effects of current drugs, further simplifying drug
regimens to improve adherence, and determining the best sequence of
regimens to manage drug resistance. Only a vaccine is postulated to be
able to halt the pandemic. This is because a vaccine would possibly cost
less, thus being affordable for developing countries, and would not
require daily treatments.*93] However, after over 20 years of research,
HIV-1 remains a difficult target for a vaccine.*93]
A number of studies have shown that measures to prevent opportunistic
infections can be beneficial when treating patients with HIV infection
or AIDS. Vaccination against hepatitis A and B is advised for patients
who are not infected with these viruses and are at risk of becoming
infected.*94] In addition, AIDS patients should receive vaccination
against Streptococcus pneumoniae and should receive yearly vaccination
against influenza virus.*citation needed] Patients with substantial
immunosuppression are also advised to receive prophylactic therapy for
Pneumocystis jiroveci pneumonia (PCP), and many patients may benefit
from prophylactic therapy for toxoplasmosis and Cryptococcus meningitis.
Various forms of alternative medicine have been used to treat symptoms
or alter the course of the disease.*94]High doses of vitamin C have been
used, for example, to treat AIDS, with good preliminary clinical
results. *95] In the first decade of the epidemic when no useful
conventional treatment was available, a large number of people with AIDS
experimented with alternative therapies. The definition of "alternative
therapies" in AIDS has changed since that time. Then, the phrase often
referred to community-driven treatments, untested by government or
pharmaceutical company research, that some hoped would directly suppress
the virus or stimulate immunity against it. These kinds of approaches
have become less common over time as the benefits of AIDS drugs have
become more apparent. Examples of alternative medicine that people hoped
would improve their symptoms or their quality of life include massage,
herbal and flower remedies and acupuncture;*94] when used with
conventional treatment, many now refer to these as "complementary"
approaches. None of these treatments have been proven in controlled
trials to have any effect in treating HIV or AIDS.*96]