Is there treatment
against HIV and AIDS? Till today, there is no conclusive treatment to
eliminate HIV from the body; however, timely treatment of opportunistic
infections can keep one healthy for many years. The commonly
available treatment for AIDS is the treatment against opportunistic
infections. Normally standard treatment regimens, used against
such infections in non-HIV patients, also work well with the
HIV-infected persons. If properly treated, almost all the opportunistic
infections can be contained.
However, during the last decade, researchers have
developed powerful drugs that check the replication of the
virus at various levels. Called Antiretroviral drugs, they
are available in three classes and under various brands.
Taken in combination (called cocktail or combination therapy)
under specialised medical advice, these drugs drastically reduce
the viral load in blood. However, they do not permanently cure
one of HIV. This line of treatment, called HAART (highly Active
Antiretroviral Therapy) has indeed resulted in a huge reduction
or AIDS-related deaths. Though many positive persons and caregivers
have welcomed these drugs, others have experienced serious
side effects. They are also very expensive and are out of reach
for majority of the infected people. But of late, the prices
have been steeply falling.
The three classes of drugs are:
- Nucleoside analogue Reverse Transcriptase
Inhibitors (NRTIs). NRTIs were the first antiretroviral
drugs to be developed. They inhibit the replication of
HIV in the early stage by inhibiting an enzyme (which is
necessary for viral replication) called Reverse Transcriptase.
The drugs include Zidovudine (Retrovir, AZT), Lamivudine
(Epivir, 3TC), Didanosine (Videx, ddI), Zalcitabine (Hivid,
ddC), Stavudine (Zerit, d4T) and Abacavir (Ziagen).
The major reported side effect of Zidovudine is bone marrow suppression,
which causes a decrease in the number of red and white blood cells. The drugs
ddI, ddC and d4T can damage peripheral nerves (peripheral neuropathy), leading
to tingling and burning in the hands and feet. Treatment with ddI can also
cause pancreatitis, and ddC may cause mouth ulcers. Approximately 5 percent
of people treated with Abacavir experience hypersensitivity reactions such
as a rash along with fever, fatigue, nausea, vomiting, diarrhea and abdominal
pain. Hypersensitivity reactions can also occur without a rash. In either
case, symptoms usually appear within the first 6 weeks of treatment and generally
disappear when the drug is discontinued. If a person had a hypersensitivity
reaction to Abacavir, he/she should avoid taking the drug again.
- Non-Nucleoside Reverse Transcriptase Inhibitors
(NNRTIs). These drugs bind directly to the enzyme,
Reverse Transcriptase. There are three NNRTIs currently
approved for clinical use: Nevirapine (Viramune), Delavirdine
(Rescriptor) and Efavirenz (Sustiva). A major side effect
of all NNRTIS is a rash. In addition, people taking Efavirenz
may have side effects such as abnormal dreams, sleeplessness,
dizziness and difficulty concentrating.
- Protease inhibitors (PIs). PIs interrupt
HIV replication at a later stage in its life cycle by interfering
with an enzyme known as HIV protease. This causes HIV particles
in the body to become structurally disorganized and noninfectious.
Among these drugs are Saquinavir (Fortovase), Ritonavir (Norvir),
Indinavir (Crixivan), Nelfinavir (Viracept), Amprenavir (Agenerase)
and Lopinavir (Kaletra).
The most common side effects of PIs include nausea, diarrhea and other digestive
tract problems. They can also cause a significant number of side effects
when they interact with certain other medications. That is because all PIs,
to one degree or another, affect an enzyme system in the liver that is responsible
for metabolizing a large number of drugs. Newer side effects have also appeared
with the continuing and widespread use of Protease Inhibitors. These include
elevated triglyceride levels and problems with sugar metabolism that may
sometimes progress to diabetes.
There may also be abnormalities in the way fat is metabolised and deposited
in the body. Some people lose much of their total body fat while others gain
excess fat on the back between their shoulders (buffalo hump) or in the stomach
(protease paunch). Right now, no one knows exactly why these abnormalities
occur. In fact, it is not even certain whether these problems are a direct
result of treatment with protease inhibitors or due to some other cause that
has yet to be identified. Similar metabolic abnormalities have occurred in
people on antiretroviral therapy that does not include PIs. Although these
body changes can be distressing, the possibility they may occur should not
stop one from obtaining treatment for HIV/AIDS.
In simple combination therapy, some physicians
prescribe a combination of RTIs. But in HAART, which in fact
has made a dramatic change in AIDS treatment, a combination
of RTIs and PIs is prescribed.
People respond differently to treatment and maintaining
the drug schedule is extremely important. Indiscriminate treatment
results in drug resistance and resurgence of the viral load.
Therefore it should be taken only under expert medical advice.
What about vaccines? More than a dozen HIV vaccines are currently being
tested. As of now, there is no vaccine to prevent HIV infection.
What is Mother to child Transmission? Babies born to mothers infected with HIV
may or may not be infected with the virus, but all carry
their mothers' antibodies to HIV for several months after
birth. If these babies lack symptoms, a definitive diagnosis
of HIV infection using standard antibody tests cannot be
made until after 15 months of age. By then, the babies are
unlikely to still carry their mothers' antibodies and will
have produced their own, if they are infected. New technologies
to detect HIV itself are being used to more accurately determine
HIV infection in infants between ages 3 months and 15 months.
A number of blood tests are being evaluated to determine
if they can diagnose HIV infection in babies younger than
3 months.
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