MEDICATION

In 1981 when AIDS first surfaced, there were no medicines to fight HIV infections or it’s associated infections and cancers.  Most people were told that there was nothing that could be done and that they would be dead in 5 years or less.  Since that time there have been great advances in medicine and there are now drugs to combat HIV and the opportunistic infections caused by AIDS.

HIV Medication

There have been a number of drugs for treating HIV infection that have been approved by the US Food and Drug Administration (FDA).  The first group of drugs used to treat HIV infections are called nucleoside reverse transcriptase (RT) inhibitors.  They work by interrupting HIV’s ability to make copies of itself at an early stage in its life cycle.  This slows the spread of HIV in the body and can delay the start of opportunistic infections.  Drugs in this class include

• • AZT (Azidothymidine)
• • ddC (zalcitabine)
• • ddI (dideoxyinosine)
• • d4T (stavudine)
• • 3TC (lamivudine)
• • Abacavir (ziagen)
• • Tenofovir (viread)
• • Emtriva (emtricitabine)
  

Health care providers can prescribe non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as

• • Delavridine (Rescriptor)
• • Nevirapine (Viramune)
• • Efravirenz (Sustiva) (in combination with other antiretroviral drugs)
  

The FDA also 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. They include

• • Ritonavir (Norvir)
• • Saquinivir (Invirase)
• • Indinavir (Crixivan)
• • Amprenivir (Agenerase)
• • Nelfinavir (Viracept)
• • Lopinavir (Kaletra)
• • Atazanavir (Reyataz)
• • Fosamprenavir (Lexiva)
  

The FDA has also introduced a third new class of drugs called fusion inhibitors.  Fuzeon (enfuvirtide or T-20) is the first fusion inhibitor and it works by interfering with HIV-1’s ability to enter into cells by blocking the merging of the virus with the cell membranes.  This blocks HIV’s ability to infect human immune cells.  Fuzeon is designed for use in combination with other HIV treatments.  It also may be active against HIV that has become resistant to existing antiviral treatments.

HIV can become resistant to any of these drugs so health care providers must use a combination of medications to effectively suppress the virus.  When three or more drugs are used in combination, it is referred to as highly active antiretroviral therapy (HAART).  People who are newly infected with HIV as well as people with AIDS can use this treatment.

HAART has been a major factor in reducing the number of deaths from AIDS in the US.  It is not a cure for AIDS, but it greatly improves the heath of many people with AIDS and it reduces the virus in blood to nearly undetectable levels.  It does not completely eliminate the virus as HIV can hide in places such as the lymph nodes, brain, testes, and retina of the eye.

Side effects

Despite the beneficial effects of HAART, there are some severe side effects that can occur.  Some of the nucleoside RT inhibitors may cause increases or decreases of red or white blood cells.  This occurs more frequently when taken in the later stages of the disease.  Some of the medications may cause inflammation of the pancreas and painful nerve damage.  There have been reports of severe reactions, including death, to some of the antiretroviral nucleoside analogs when used alone or in combination with another drug.  It is recommended that people see their heath care professional frequently.

The most common side effects with protease inhibitors are nausea, diarrhea and other gastrointestinal symptoms.  Also, they can interact with other drugs resulting in serious side effects.  Fuzeon may cause severe allergic reactions such as pneumonia, trouble breathing, chills and fever, skin rash, blood in urine, vomiting, and low blood pressure.

If you are taking HIV drugs, you should contact your health care provider immediately if you 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

The treatments used to treat Kaposi’s sarcoma or other cancers associated with HIV infections are radiation, chemotherapy or injections of alpha interferon.

PREVENTION

There is no cure or vaccine for HIV.  The only way to prevent infection is to avoid behaviors that put you at risk, such as sharing needles and having unprotected sex.  Many people who are infected with HIV have no symptoms.  There is no way of knowing if your sexual partner is infected unless he or she has repeatedly tested negative for HIV and does not engage in risky behavior.  The best protection is to abstain from having sex or use male latex condoms during sex.  Some laboratory evidence shows that spermicides can kill HIV, however there is no proof that it will protect a person from getting the virus.

RESEARCH

There is an abundance of ongoing research on all areas of HIV infection.  These include testing preventative vaccines and new medications to combine multiple drugs into one pill.  This will help to eliminate complications that arise from a person missing a dose of their medication.  Researchers are investigation exactly how HIV damages the immune system.  This will hopefully help them develop more effective drugs and vaccines.

Scientists are also investigating chemical barriers such as topical microbicides that people can use during sex to prevent HIV transmission.  They are also looking at ways to prevent transmission from mother and child.

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