YOUR HEALTH What you need to know about HIV/AIDS and Antiretroviral Treatment Posted by on May 11, 2007, 13:39

An estimated 38 million people are living with the HIV globally and over 20 million have died of AIDS related illnesses since the inception of the disease. About 70 percent of the total number is in Sub Saharan Africa with about 57 percent being women and girls. Sierra Leone has a 1.53% prevalence rate among its general   and over 500 have died since the first HIV positive case was discovered in the country in 1987. 

Since its outbreak, there is still no vaccine or cure for the HIV infection or AIDS. Yet, there are formidable treatments for HIV and AIDS that can make a person with HIV live longer than normally expected. These are called  Antiretroviral therapy (ARVs).The government of Sierra Leone through it National response programme has obtained HIV/AIDS treatment drugs for 300 people living with HIV in Sierra Leone to be administered free of charge to deserving people. ARVs are very effective drugs in treating HIV. But they are equally complicating and therefore needs careful attention to administer them. This fact sheet provides some basic information on the drugs and treatment that gives hope to a formally dying people.

Human immunodeficiency virus (HIV) causes infections in humans. It passes from one person to another through semen, vaginal fluid, and blood or breast milk. Although HIV can be transmitted (passed to another person) through injection needles or blades that have already been used on another person with HIV. The most common way to be infected with HIV is through unprotected sexual intercourse.

Babies can also get the infection in the womb, during birth or through the breast milk if their mothers have the virus. This does not happen every time, so the baby of an HIV positive mother might be HIV negative or HIV positive.

A person usually does not know that he or she is infected with HIV until a special blood test is done.  The test must be on the voluntary consent of the person taking the test and it must be a secret between him/herself and the counselor/service provider.

A person with HIV infection may continue to have a healthy life for some months or many years. After some time, a person with HIV may start to lose a lot of weight, feel very tired and be unable to do all their usual daily activities. Illnesses also start to happen, especially infections such as tuberculosis (TB), herpes zoster (shingles) and other skin or chest infections. These are called opportunistic infections – the effect of HIV on the immune system provides opportunities for these infections to attack. These diseases can also happen to people who are HIV-negative, but they are much more common and more dangerous when they happen to someone who has HIV.

In an HIV-positive person, these diseases are known as Acquired immune Deficiency Syndrome (AIDS). They show that a person’s immune system has become weak and cannot repair or defend the body in the usual ways that keep humans healthy. If people with AIDS do not get treatment, they will gradually become very ill and may die.

What does a person with HIV need?

A person with HIV has a right to a full range of care, support, treatment and prevention, like any other person. This means having help with any medical problems and also support for their psychosocial and economic needs and overall well-being.

Care, support and treatment for people with HIV should be comprehensive. This means that a variety of people and organizations – such as family, doctor, community and workplace – must all play their part and work together to provide a ‘continuum’ of care and prevention.

What treatment is possible for a person with HIV?

A person with HIV can get different kinds of treatment, both for the illnesses caused by HIV and for fighting the virus itself.

The simplest treatment is to make sure that a person with HIV can always get good food and clean water, as well as good basic care when they are ill. People with HIV need more protein and vitamins in their food.  This means having meat, beans, fish and plenty of vegetables and fruit.  A person with HIV also needs to have good medical treatment for opportunistic illnesses such as TB, skin or chest infections. Prompt treatment for these illnesses can help the immune system to stay stronger for a longer time.

HIV infection itself can be treated with new drugs. They are called antiretrovirals (ARVs).  ARVs reduce the effects of the virus and enable a person to become healthy again but they do not completely cure HIV infection. A person with HIV who gets ARV treatment can live a much longer and healthier life.

Some medicines for opportunistic infections are cheap and easy to use. They are often provided through home based care, or at clinics or hospitals.  ARVs and some other medicines are more expensive and difficult to use. They might be provided through special clinics and the person with HIV might need special support to use them.

What is ARV treatment?

Antiretroviral (ARV) treatment is treatment for HIV infection that includes using drugs that interfere with the way that the HIV virus reproduces in the body. ARVs reduce a person’s viral load. This means that they reduce the number of viruses in their body.  They lower the ability of HIV to damage the immune system (the body’s natural defence). It means that the immune system can recover its ability to defend a person from attack by other infections, enabling them to stay healthy and live longer.  ARV treatment must be taken for life. If not, the virus will start to reproduce again and will cause AIDS.

ARVs do not destroy HIV – but they can reduce its effects and help a person to live a longer life.

What difference does ARV treatment make?

ARVs can bring a person with AIDS back to good health and keep a person with HIV healthy.

A person who takes ARVs can live a much longer and healthier life than someone who does not.

What types of ARV treatment are there and how are they combined?

There are three main types of ARV drugs to treat people with HIV. Each one attacks the virus in a different way.

ARVs work best when different types are used together and when at least three different drugs are used. This is known as combination therapy or Highly Active Antiretroviral Therapy (HAART). Using just one or two ARVs for long-term treatment is not usually effective.

To prevent mother-to-child transmission (PMTCT) of HIV, just one or two types of ARVs can be used for a short time. This protects the baby from becoming infected by its mother’s virus during birth. It does not affect the woman’s own level of HIV. Thus the mother will have to take her own treatment of ARVs after delivery.

When does a person need ARV treatment?

ARV treatment usually starts only when HIV has damaged a person’s immune system.  A doctor can find out what is happening to the immune system of a person with HIV by carefully examining him/her and checking for any illnesses or problems.

Special blood tests can be used depending on the level of resources available. These include:

s Tests for anemia and white blood cells

s A CD4 count test. This shows how much damage HIV has done to the immune system and guides the doctor about when to start treatment.

s A viral load test. This shows how much HIV virus is in the body.

Sierra Leone has a CD4 counter machine ( the only in the MRU) and can be accessed through the Health Sector Response Group in The National HIV Secretariat at King Harman Road

How does ARV look like and how is ARV treatment used?

ARV medicines are usually tablets, capsules or, sometimes, liquids. These are taken by mouth.

Some ARVs must be taken when the stomach is empty, but others only after eating some food.

They must be taken at specific times each day. This is because the amount of drug in the body must remain at the same level all of the time.

ARVs do not cure HIV. So, treatment must continue every day for the rest of a person’s life – this is called adherence to treatment. 

Prevention must also continue every day for the rest of a person’s life. This is a big commitment. So, a person with HIV and their doctor must work together to identify which drugs fit in best with their life. They must also make sure that the person’s condition is regularly monitored - to check if the treatment is working and that any side effects are managed properly.

What is adherence to ARV treatment?

Adherence means taking doses of drugs and sticking to the treatment plan exactly as prescribed. It means taking the correct amount of drugs, at the correct time and in the correct way.  At least 95% adherence is needed for ARVs to work effectively. Missing even a few doses can cause treatment to fail, opportunistic infections (OIs) or drug resistance to start. Adherence is especially difficult if people are isolated, depressed, forgetful or worrying too much about the effects of their medication.

Note

A person with HIV should work with his/her doctor, pharmacist and treatment supporters to find ways to help with adherence. These might include: getting support from family and friends; having regular check ups; getting prompt help with side effects; and being able to talk to others who take ARVs.

What are the side effects of ARVs?

Side effects are the unintended effects of a drug. Different ARVs cause different side effects. Not all of them are experienced by all people. It is vital to ensure a person knows about possible side effects before he or she starts to take ARVs.

Some side effects – usually nausea, diarrhea or tiredness – may appear soon after a person starts taking ARVs. However, they often do not last long and treatment can continue without problems.

Other ARV side effects include skin rash, dry skin, chapped lips, insomnia, sexual problems, mood changes and difficulties in moving or walking. Some long-term side effects can be very serious. They may appear mild at first, but can indicate major problems. These include peripheral neuropathy, liver damage and lipodystrophy.  There are many different ways to manage side effects. However, if they are severe, a person’s doctor might decide to change his/her treatment.

Can a person use alcohol, tobacco or other drugs when taking ARV treatment?

ARVs and many other substances affect each other in different ways. These include prescription drugs, other medicines (cough remedies, pain killers, and vitamins), alcohol, tobacco, cannabis, and narcotics.

A person who is prescribed ARVs must tell his/her doctor or pharmacist what else they are taking. Some substances will have no effect on a person’s ARV treatment, but others might change the effectiveness of the drugs. A person might have to change or stop using substances that interfere with ARVs, especially if the liver is not working well.

Is drug resistance a problem with ARV treatment?

Drug resistance happens when the HIV virus changes so that a particular drug cannot attack it.

When this happens, ARVs can become ineffective; then a person’s viral load increases and the immune system starts to be damaged again.

Drug resistance happens much more easily if a few ARV doses are missed or taken at the wrong time. If a person’s treatment fails, the doctor will try to change to a different type of HAART. This might mean having more complicated & expensive treatment with up to 4 or 5 drugs.

A person with drug-resistant HIV can pass it on to others, meaning they too will need special HAART.

Essential points about ARV treatment:

ARVs enable a person with HIV to have a better and longer life. But they do not cure a person of HIV.

ARVs must be taken continuously and correctly for the whole lifetime of a person with HIV.

Even if a person is taking ARVs and has a very low viral load, they can still infect other people with HIV.

REMEMBER YOU CAN SAVE LIVES, INCLUDING YOURS WHEN YOU KNOW YOUR HIV STATUS.

GET TESTED FOR HIV NOW. THE TEST IS FREE, IT IS CONFIDENTIAL

For more information, please contact;

Health Sector Response Group at National HIV Secretariat, 15 Kingharman Road, 34 Military Hospital, Marie Stopes Clinic, Urban Centre, Kissy or your district hospital for free and confidential HIV test.