Anti-HIV/AIDS Medications

I am HIV positive. Do I need to take anti-
HIV medications?
You do not necessarily need to take anti-HIV (also called
antiretroviral) medications just because you are HIV
positive. You and your doctor will determine the best time
to start treatment. When to take anti-HIV medications
depends on your overall health, the amount of virus in
your blood (viral load), and how well your immune
system is working.
How will I know when to start anti-HIV
medications?
You should start treatment if:
• you are experiencing severe symptoms of HIV infection
 or have been diagnosed with AIDS
• your CD4 count is 350 cells/mm3 or less (especially if
200 cells/mm3 or less)
• you are pregnant
• you have HIV-related kidney disease
• you are being treated for hepatitis B
If anti-HIV medications can help me stay
healthy, why wait to start treatment?
Once you begin treatment, you may need to continue
taking anti-HIV medications for the rest of your life.
Although newer anti-HIV medications are easier to
take, starting treatment usually means a significant
adjustment in your lifestyle. Some anti-HIV/AIDS medications
need to be taken several times a day at specific times
and may require a change in the foods you eat, when
you eat meals, and when you take other medications.
In addition to their desired effects, anti-HIV medications
may have negative side effects, some of which are
serious. If the virus is not suppressed completely, drug
resistance can develop. Side effects and drug resistance
may limit your future treatment options.
 
Terms Used in This Fact Sheet:
AIDS: Acquired Immune Deficiency Syndrome. AIDS is the
most severe form of HIV infection. HIV infected patients are
diagnosed with AIDS when their CD4 count falls below 200
cells/mm3 or if they develop an AIDS-defining illness (an
illness that is very unusual in someone who is not HIV
positive).
Antiretroviral: a medication that interferes with replication of
retroviruses. HIV is a retrovirus.
CD4 count: CD4 cells, also called T cells or CD4+ T cells, are
white blood cells that fight infection. HIV destroys CD4 cells,
making it harder for your body to fight infections. A CD4
count is the number of CD4 cells in a sample of blood.
Drug resistance testing: A laboratory test to determine if an
individual’s HIV strain is resistant to any anti-HIV
medications. HIV can mutate (change form), resulting in HIV
that cannot be controlled with certain medications.
Viral load: the amount of HIV in a sample of blood.
 
What treatment is right for me?
The U.S. Department of Health and Human Services
(HHS) provides HIV treatment guidelines to doctors and
patients. These guidelines recommend that you take a
combination of three or more medications from different
classes (see Approved Medications to Treat HIV
Infection Fact Sheet) in a regimen called Highly Active
Antiretroviral Therapy (HAART). The guidelines list
«preferred» HAART regimens. However, your regimen
should be tailored to your needs. Factors to consider in
selecting a treatment regimen include:
• your drug resistance testing results
• number of pills
• how often the pills must be taken
• if pills can be taken with or without food
• how the medications interact with one another
• other medications you take
• other diseases or conditions
• pregnancy

HIV/AIDS in Pregnancy

HIV/AIDS 
 
HIV stands for human immunodeficiency virus (HIV). HIV causes AIDS. AIDS stands for acquired immune deficiency syndrome. Almost all people who have HIV go on to develop AIDS. People who have AIDS cannot fight off diseases. They usually get serious infections, certain cancers, and other life-threatening diseases. 
In the United States, HIV is most often spread by:
 
Having unprotected sex with an infected person.
Coming into contact with infected blood. In the United States, the most common way for this to happen is for drug users to share needles.
Many people who are infected with HIV do not have symptoms at first. Early signs of HIV infection are:
 
Fever
Headache
Tiredness
Enlarged lymph nodes (glands in the neck and groin)
Health care providers diagnose HIV infection with a blood test.
 
There is no cure for HIV or AIDS. But HIV-fighting drugs can slow the disease and prolong life. The U.S. Public Health Service recommends that pregnant women who are infected with HIV take these drugs.
 
Each year about 6,000 women living with HIV give birth. Many do not know they have the virus. An infected woman can pass the virus to her baby during pregnancy, delivery or breastfeeding. Drugs can dramatically decrease the risk that a mother will transmit the disease to her baby at the time of birth.
 
What you can do:
Ask your health care provider to screen you for HIV before you’re pregnant or early in pregnancy. The March of Dimes urges all women who think they may have been exposed to HIV to get tested before they become pregnant.
 
Ask your partner to also be screened.
 
While you’re pregnant, you can avoid HIV infection by not having sex and by not using needles that may be infected. If you do have sex: 
 
Have sex with only one partner who is only having sex with you, has been tested for HIV, and is uninfected
Use a latex condom
If you are infected with HIV or have AIDS, do not breastfeed your baby.

Reproductive Health

What is reproductive health?
Reproductive health includes a variety of topics, such as:
 
Menstruation and menopause
Pregnancy and preconception care
Fertility/Infertility
Contraception
Sexually transmitted diseases and AIDS/HIV
Health and function of the male and female reproductive systems
More information on many of these issues is provided below.
 
What is the menstrual cycle?
The menstrual cycle is the process by which a woman’s body gets ready for the chance of a pregnancy each month. The average menstrual cycle is 28 days from the start of one to the start of the next, but it can range from 21 days to 35 days.
 
Most menstrual periods last from three to five days. In the United States, most girls start menstruating at age 12, but girls can start menstruating between the ages of 8 and 16.
 
Visit the menstruation and menstrual cycle health topic for more detailed information.
 
What is pregnancy?
Pregnancy is the term used to describe when a woman has a growing fetus inside of her. In most cases, the fetus grows in the uterus.
 
Human pregnancy lasts about 40 weeks, or just more than 9 months, from the start of the last menstrual period to childbirth.
 
Visit the pregnancy health topic for more detailed information.
 
What are prenatal and preconception care and why are they important?
Prenatal care is the care woman gets during a pregnancy. Getting early and regular prenatal care is important for the health of both mother and the developing baby.
 
In addition, health care providers are now recommending a woman see a health care provider for preconception care, even before she considers becoming pregnant or in between pregnancies.
 
Both preconception care and prenatal care help to promote the best health outcomes for mother and baby.
 
What is infertility?
Infertility is the term health care providers use for women who are unable to get pregnant, and for men who are unable to impregnate a woman, after at least one year of trying.
 
In women, the term is used to describe those who are of normal childbearing age, not those who can’t get pregnant because they are near or past menopause. Women who are able to get pregnant but who cannot carry a pregnancy to term (birth) may also be considered infertile.
 
Infertility is a complex problem – it does not have a single cause because getting pregnant is a multi-step chain of events. The cause of infertility can rest in the women or the man, or can be from unknown factors or a combination of factors.
 
Visit the fertility/infertility health topic to learn more about the possible causes and treatments for infertility.
 
What is contraception?
Contraception, also known as birth control, is designed to prevent pregnancy. Some types of birth control include (but are not limited to):
 
Barrier methods, such as condoms, the diaphragm, and the cervical cap, are designed to prevent the sperm from reaching the egg for fertilization.
Intrauterine device, or IUD, is a small device that is inserted into the uterus by a health care provider. The IUD prevents a fertilized egg from implanting in the uterus. An IUD can stay in the uterus for up to 10 years until it is removed by a health care provider.
Hormonal birth control, such as birth control pills, injections, skin patches, and vaginal rings, release hormones into a woman’s body that interfere with fertility by preventing ovulation, fertilization, or implantation.
Sterilization is a method that permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant. Sterilization involves surgical procedures that must be done by a health care provider and usually cannot be reversed.
The choice of birth control depends on factors such as a person’s overall health, age, frequency of sexual activity, number of sexual partners, desire to have children in the future, and family history of certain diseases. A woman should talk to her health care provider about her choice of birth control method.
 
It is important to remember that even though birth control methods can prevent pregnancy, they do not all protect against sexually transmitted diseases or HIV.

Neurological Complications of AIDS Fact Sheet

What is AIDS?
 
AIDS (acquired immune deficiency syndrome) is a condition that occurs in the most advanced stages of human immunodeficiency virus (HIV) infection.  It may take many years for AIDS to develop following the initial HIV infection.
Although AIDS is primarily an immune system disorder, it also affects the nervous system and can lead to a wide range of severe neurological disorders.
How does AIDS affect the nervous system?
 
The virus does not appear to directly invade nerve cells but it jeopardizes their health and function.  The resulting inflammation may damage the brain and spinal cord and cause symptoms such as confusion and forgetfulness, behavioral changes, severe headaches, progressive weakness, loss of sensation in the arms and legs, and stroke.  Cognitive motor impairment or damage to the peripheral nerves is also common.  Research has shown that the HIV infection can significantly alter the size of certain brain structures involved in learning and information processing.
Other nervous system complications that occur as a result of the disease or the drugs used to treat it include pain, seizures, shingles, spinal cord problems, lack of coordination, difficult or painful swallowing, anxiety disorder, depression, fever, vision loss, gait disorders, destruction of brain tissue, and coma.  These symptoms may be mild in the early stages of AIDS but can become progressively severe.
In the United States , neurological complications are seen in more than 40 percent of adult patients with AIDS.  They can occur at any age but tend to progress more rapidly in children.  Nervous system complications in children may include developmental delays, loss of previously achieved milestones, brain lesions, nerve pain, smaller than normal skull size, slow growth, eye problems, and recurring bacterial infections
How are these disorders treated?
 
No single treatment can cure the neurological complications of AIDS.  Some disorders require aggressive therapy while others are treated symptomatically.
Neuropathic pain is often difficult to control.  Medicines range from analgesics sold over the counter to antiepileptic drugs, opiates, and some classes of antidepressants.  Inflamed tissue can press on nerves, causing pain.  Inflammatory and autoimmune conditions leading to neuropathy may be treated with corticosteroids, and procedures such as plasmapheresis (or plasma exchange) can clear the blood of harmful substances that cause inflammation.
Treatment options for AIDS- and HIV-related neuropsychiatric or psychotic disorders include antidepressants and anticonvulsants.  Psychostimulants may also improve depressive symptoms and combat lethargy.  Antidementia drugs may relieve confusion and slow mental decline, and benzodiazepines may be prescribed to treat anxiety.  Psychotherapy may also help some patients.
Aggressive antiretroviral therapy is used to treat AIDS dementia complex, vacuolar myopathy, progressive multifocal leukoencephalopathy, and cytomegalovirus encephalitis.  HAART, or highly active antiretroviral therapy, combines at least three drugs to reduce the amount of virus circulating in the blood and may also delay the start of some infections.
Other neuro-AIDS treatment options include physical therapy and rehabilitation, radiation therapy and/or chemotherapy to kill or shrink cancerous brain tumors that may be caused by the HIV virus, antifungal or antimalarial drugs to combat certain bacterial infections associated with the disorder, and penicillin to treat neurosyphilis.

Immune Systems of AIDS Patients More Prone to HPV Cancers

As their immune system weakens, people with AIDS are at increased risk for human papillomavirus (HPV)-related cancers, a new study has found.
 
It was known that people with AIDS had a greater risk for HPV-associated cancers of the anus, cervix, penis, vagina, vulva and oropharynx. However, the extent to which AIDS-related weakening of the immune system played a role wasn’t clear, the researchers pointed out.
 
For this study, researchers at the U.S. National Cancer Institute analyzed cancer registry data on almost 500,000 people diagnosed with AIDS between 1980 and 2004. They found that people with AIDS had a statistically significant higher risk for all HPV-related cancers.
 
«Given that individuals currently infected with HIV may obtain little benefit from available HPV vaccines…our results underscore the need for effective screening for cervical cancer and anal cancer among persons with HIV infections or AIDS,» the researchers wrote.
 
The study was published online July 31 in the Journal of the National Cancer Institute.
 
While it does offer new evidence of the link between HIV/AIDS and HPV-related cancer or bladder cancer , the study doesn’t actually prove a biological connection, Dr. Howard D. Strickler, of the Department of Epidemiology and Population Health at Albert Einstein College of Medicine, wrote in an accompanying editorial.

Paclitaxel Injection

Why is this medication prescribed?
 
Paclitaxel manufactured with human albumin is used to treat breast cancer that has not improved or that has come back after treatment with other medications. Paclitaxel manufactured with Cremophor EL is used to treat ovarian cancer (cancer that begins in the female reproductive organs where eggs are formed), breast cancer, and lung cancer. Paclitaxel with Cremophor EL is also used to treat Kaposi’s sarcoma (a type of cancer that causes patches of abnormal tissue to grow under the skin) in people who have acquired immunodeficiency syndrome (AIDS). Paclitaxel is in a class of medications called antimicrotubule agents. It works by stopping the growth and spread of cancer cells.
 
How should this medicine be used?
 
Paclitaxel comes as a liquid to be given intravenously (into a vein) by a doctor or nurse in a hospital or clinic. It is usually given once every 3 weeks. When paclitaxel manufactured with Cremophor EL is used to treat Kaposi’s sarcoma, it may be given once every 2 or 3 weeks.
 
Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
 
Other uses for this medicine
 
Paclitaxel is also sometimes used to treat cancer of the head and neck, esophagus (tube that connects the mouth and stomach), bladder, endometrium (lining of the uterus), and cervix (opening of the uterus). Talk to your doctor about the risks of using this medication for your condition.
 
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What other information should I know?
 
Keep all appointments with your doctor.
 
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
How Many People Have HIV and AIDS?
Since the discovery of the virus more than 20 years ago, millions of people throughout the world have been infected with HIV. Most are adults, but there are kids and teens who have HIV, too. In the world today, AIDS remains an epidemic (say: eh-puh-deh-mik), which means that it affects a large number of people and continues to spread rapidly.
 
Right now, about 40 million people in the world are living with HIV infection or AIDS. This estimate includes 37 million adults and 2.5 million children. In the United States alone, more than 1 million people are living with HIV.
 
How Is HIV Spread?
HIV infection isn’t like a cold or the flu. A person cannot get HIV by hugging or holding the hand of, sharing a school bus or classroom with, or visiting the home of someone who has HIV. HIV is passed only through direct contact with another person’s body fluids, such as blood. The majority of people in North America get infected with HIV by:
 
having sexual contact with a person who has HIV
sharing needles or syringes (used to inject illegal drugs) with a person who has HIV
Other ways of getting HIV can occur when:
 
an infected pregnant woman passes it to her unborn child. (This can be prevented by treating the mother and child around the time the baby is delivered.) Because of the risk to an untreated baby, every pregnant woman should be tested for HIV.
a person has a blood transfusion (say: trans-fyoo-zhun) from a fairly large volume of blood. But in North America today, all donated blood is tested for HIV, so the risk of getting HIV is less than one in a million.

HIV/AIDS

Treatment
When AIDS first surfaced in the United States, there were no drugs to combat the underlying immune deficiency, and few treatments existed for the opportunistic diseases that resulted. Researchers, however, have developed drugs to fight both HIV infection and its associated infections and cancers.
 
HIV infection
The Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection.
 
RT Inhibitors
The first group of drugs, called reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus, making copies of itself. Nucleoside/nucleotide RT inhibitors are faulty DNA building blocks. When these faulty pieces are incorporated into the HIV DNA (during the process when the HIV RNA is converted to HIV DNA), the DNA chain cannot be completed, thereby blocking HIV from replicating in a cell. Non-nucleoside RT inhibitors bind to reverse transcriptase, interfering with its ability to convert the HIV RNA into HIV DNA. This class of drugs may slow the spread of HIV in the body and delay the start of opportunistic infections.
 
Protease Inhibitors
FDA has approved a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt the virus from making copies of itself at a later step in its life cycle.
 
Fusion Inhibitors
FDA also has introduced a third new class of drugs, known at fusion inhibitors, to treat HIV infection. Fuzeon (enfuvirtide or T-20), the first approved fusion inhibitor, works by interfering with the ability of HIV-1 to enter into cells by blocking the merging of the virus with the cell membranes. This inhibition blocks HIV’s ability to enter and infect the human immune cells. Fuzeon is designed for use in combination with other anti-HIV treatments. It reduces the level of HIV infection in the blood and may be effective against HIV that has become resistant to current antiviral treatment schedules.
 
HAART
Because HIV can become resistant to any of these drugs, healthcare providers must use a combination treatment to effectively suppress the virus. When multiple drugs (three or more) are used in combination, it is referred to as highly active antiretroviral therapy, or HAART, and can be used by people who are newly infected with HIV as well as people with AIDS. Recently, FDA approved the first one-a-day, three-drug combination pill called Atripla.
 
Researchers have credited HAART as being a major factor in significantly reducing the number of deaths from AIDS in this country. While HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS, and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Researchers, however, have shown that HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye, even in people who have been treated.
 
Side effects
Despite the beneficial effects of HAART, there are side effects associated with the use of antiviral drugs that can be severe. Some of the nucleoside RT inhibitors may cause a decrease of red or white blood cells, especially when taken in the later stages of the disease. Some may also cause inflammation of the pancreas and painful nerve damage. There have been reports of complications and other severe reactions, including death, to some of the antiretroviral nucleoside analogs when used alone or in combination. Therefore, health experts recommend that anyone on antiretroviral therapy be routinely seen and followed by their healthcare provider.
 
The most common side effects associated with protease inhibitors include nausea, diarrhea, and other gastrointestinal symptoms. In addition, protease inhibitors can interact with other drugs, resulting in serious side effects. Fuzeon may also cause severe allergic reactions such as pneumonia, difficult breathing, chills and fever, skin rash, blood in urine, vomiting, and low blood pressure. Local skin reactions are also possible since it is given as an injection underneath the skin. People taking HIV drugs should contact their healthcare providers immediately if they have any of these symptoms.
 
Opportunistic infections
A number of available drugs help treat opportunistic infections. These drugs include
 
Foscarnet and ganciclovir to treat CMV (cytomegalovirus) eye infections
Fluconazole to treat yeast and other fungal infections
TMP/SMX (trimethoprim/sulfamethoxazole) or pentamidine to treat PCP (Pneumocystis carinii pneumonia)
Cancers
Healthcare providers use radiation, chemotherapy, or injections of alpha interferon—a genetically engineered protein that occurs naturally in the human body—to treat Kaposi’s sarcoma or other cancers associated with HIV infection.

HIV, AIDS and Older People

Grace was dating again. George, a close family friend she had known for a long time, was starting to stay overnight more and more often. Because she was past childbearing age, Grace didn’t think about using condoms. And because she had known George for so long, she didn’t think to ask him about his sexual history. So, Grace was shocked when she tested positive for HIV.
 
What Is HIV? What Is AIDS?
 
Like most people, you probably have heard a lot about HIV and AIDS. You may have thought that these diseases weren’t your problem and that only younger people have to worry about them. But anyone at any age can get HIV/AIDS.
 
HIV (short for human immunodeficiency virus) is a virus that damages the immune system—the system your body uses to fight off diseases. HIV infection leads to a much more serious disease called AIDS (acquired immunodeficiency syndrome). When the HIV infection gets in your body, your immune system can be made weaker. This puts you in danger of getting other life-threatening diseases, infections, and cancers. When that happens, you have AIDS. AIDS is the last stage of HIV infection. If you think you may have HIV, it is very important to get tested. Today there are drugs that can help your body keep the HIV in check and fight against AIDS.
 
What Are the Symptoms of HIV/AIDS?
 
Many people have no symptoms when they first become infected with HIV. It can take as little as a few weeks for minor, flu-like symptoms to show up, or more than 10 years for more serious symptoms to appear. Signs of HIV include headache, cough, diarrhea, swollen glands, lack of energy, loss of appetite, weight loss, fevers and sweats, repeated yeast infections, skin rashes, pelvic and abdominal cramps, sores in the mouth or on certain parts of the body, or short-term memory loss.

Early symptomatic HIV infection

Early symptomatic HIV infection is a stage of infection with the human immunodeficiency virus when symptoms are present but AIDS has not yet developed.
Early symptomatic HIV infection has signs and symptoms typical of HIV infection but not full-blown AIDS. The onset of symptoms signals the transition from asymptomatic HIV infection to HIV disease.
At this early stage of HIV infection, the person does not have signs or symptoms of AIDS such as opportunistic infections, certain cancers, or a CD4 count of less than 200.
Risk factors for HIV infection are:
Being born to an HIV-positive mother
Getting a blood transfusion or blood components
Intravenous drug use
Sexual contact with an infected partner in which there is an exchange of semen or vaginal fluids
 
Diarrhea that persists
Excessive sweating, night sweats
Fatigue that persists
Fever that persists
General feeling of discomfort, illness, or lack of well-being
Herpes zoster infections that keep coming back
Joint pain
Mouth disorders
Gingivitis
Oral hairy leukoplakia of tongue, caused by a viral infection
Oral cancer
Pain, loss of sensation, and inability to control muscles (peripheral neuropathy)
Skin disorders
Fungal infection of the skin or nails
Molluscum contagiosum
Seborrheic dermatitis
Swollen lymph glands
Weight loss
Exams and Tests

AIDS and Infections

AIDS-related opportunistic infections
Having AIDS weakens your body’s immune system. Your immune system normally fights germs that enter your body. When AIDS makes it weak, it can’t fight germs well. This can lead to serious infections that don’t often affect healthy people. These are called opportunistic infections (OIs).
 
There are many types of OIs. Tuberculosis and a serious related disease, mycobacterium avium complex (MAC) are bacterial infections. Viral infections include cytomegalovirus (CMV) and hepatitis C. Fungi cause thrush (candidiasis), cryptococcal meningitis, pneumocystis carinii pneumonia (PCP) and histoplasmosis, and parasites cause crypto (cryptosporidiosis) and toxo (toxoplasmosis).
 
Having AIDS can make any infection harder to treat. People with AIDS are also more likely to suffer complications of common illnesses such as the flu.
 
The good news is that you can help prevent infections by taking your AIDS medicines. Other things that can help include practicing safe sex, washing your hands well and often and cooking your food well.