Prevention and Treatment
There is currently no cure for HIV infection and no vaccine to protect against it, but avoiding high-risk activities such as having unprotected sex and sharing needles for injecting drugs can help to prevent its spread. Routine screening for HIV has been recommended by the Centers for Disease Control and Prevention (CDC) and several other organizations to help identify HIV infections in people who may have no signs or 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. Giving the antiretroviral drug zidovudine intravenously during labor and delivery and also to the newborn twice a day by mouth for 6 weeks reduces the rate of transmission from 25-33% to about 1-2%. A combination of antiretroviral therapies is most effective at reducing the risk of HIV transmission to the baby.
Healthcare workers can protect themselves from HIV infection by following universal precautions, such as wearing gloves and avoiding needle sticks.
While there is no vaccine that prevents HIV, the CDC and the World Health Organization (WHO) recommend that individuals without HIV infection but at high risk for it consider taking pre-exposure prophylaxis (PrEP), a daily pill to help prevent infection. For people taking PrEP consistently, the risk of HIV infection was up to 92% lower compared to those who didn't take it.
The goals of HIV and AIDS treatment are to suppress the virus 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 effects and toxicity.
The U.S. Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents as well as WHO recommend that all individuals diagnosed with HIV receive treatment as soon as possible, including pregnant women. With advances in treatment, individuals with HIV are living longer, healthier lives. Once someone begins treatment, it is important that the person continue it for the rest of their life to help maintain health and prevent spread of HIV. 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.
A person may be infected with drug-susceptible and/or drug-resistant strains of HIV. Testing for drug resistance is performed when a person is first diagnosed to help guide therapy. There are several classes of antiretroviral drugs used to treat HIV/AIDS. People typically take at least three drugs from two different classes in order to prevent or minimize virus replication and the emergence of drug-resistant strains. Combinations of three or more antiretroviral drugs are referred to as highly active antiretroviral therapy or HAART. 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 he or she is infected.
Drug therapies may be 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. Another reason treatment may be changed is if the individual experiences significant side effects and toxicity. This may be related to the person's ability to absorb and metabolize the drug(s).
People with HIV/AIDS will need to work closely with their healthcare provider(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 health practitioners who specialize in the management of "treatment-experienced" patients. New HIV/AIDS drug treatments are continually being developed and brought into clinical use.
For more details, read Overview of Treatments from AIDS.gov.