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Human Immunodeficiency Virus

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Prevention and Treatment

There is currently no cure for HIV infection, but avoiding high-risk activities such as unprotected sex and sharing needles can prevent most cases. Routine screening for HIV antibodies has been recommended by the CDC to help identify HIV infections in those who may have no symptoms. The early diagnosis of HIV infection is important to prevent its transmission to others and to allow evaluation, monitoring, and early treatment of the affected person.

Treatment of HIV-infected mothers during pregnancy, precautions at birth, and avoiding breast-feeding can minimize the risk of passing the infection from mother to child.

Health care workers can protect themselves from HIV infection by following universal precautions, such as wearing gloves and avoiding needle sticks.

Treatment

The goals of HIV and AIDS treatment are to suppress viral replication to undetectable levels and to preserve the person's immune function and health. Suppressing viral replication prevents or inhibits HIV mutation and the development of drug resistance. It slows the progression of the disease and allows the number of CD4 T-cells to increase, improving immune function. Treatment of complications and opportunistic infections is also important, as is addressing drug therapy side affects and toxicity.

There are two key considerations with HIV/AIDS treatment. The first is when to begin treatment and the second is which specific medications to prescribe. A Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents recommends initiating treatment in someone with HIV when the person has an AIDS-defining illness or when their CD4 T-cell count is less than 200 cells/mm3. They also recommend consideration of treatment for those whose CD4 T-cell count is between 200 and 350 cells/mm3 and recommend treatment for all people regardless of CD4 T-cell count if they:

Pregnant women who do not otherwise meet treatment criteria may consider whether or not to continue drug therapy after their baby is born. In most other cases, once treatment has been started in a person, it is important that it be taken consistently for the rest of the person's life. Interruptions in treatment can lead to increases in the amount of virus (viral load) and can increase the risk of developing drug resistance, decrease immune function, and allow disease progression.

Drug selection
Depending on the source of their HIV infection, a person may start with a drug-susceptible or -resistant strain of HIV. Because HIV mutates readily as it replicates and is exposed to drug therapy, the virus "population" that a person is infected with is mixed (heterogeneous). Without drug treatment, a drug-susceptible wild-type of HIV generally predominates. As the person is treated with HIV drugs, the population changes, with a decrease in the susceptible wild-type virus and an increase in drug-resistant virus. In order to prevent or minimize viral replication and the emergence of drug-resistant HIV, multiple drugs are combined for therapy.

There are several classes of antiretroviral drugs that are currently used to treat HIV/AIDS. People typically take at least two drugs from different classes. Combinations of three or more antiretroviral drugs are referred to as HAART. Additional medications may be prescribed to address complications, co-infections, and drug side effects such as gastrointestinal upset. There are preferred treatment regimens, but the specific drugs given must be tailored to the individual and to the strain(s) of HIV with which they are infected. HIV drug resistance is usually evaluated when a person is first diagnosed with HIV and again prior to the initiation of treatment.

Drug therapies are then evaluated and changed as necessary if the person experiences treatment failure – indicating the development of resistance to one or more of the drugs the person is taking – or if there are changes in the person's ability to absorb and metabolize the drug(s).

People with HIV/AIDS will need to work closely with their doctor(s) throughout their lifetime to adjust their medications to their changing needs. Treatment of people who have developed resistance to one or more drugs or classes of drugs can become challenging. Those affected may need to consult with doctors who specialize in the management of "treatment-experienced" patients. New HIV/AIDS drug treatments are continually being developed and brought into clinical use.

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