Is there a cure for HIV/AIDS?
No, there is no cure for HIV/AIDS. Progression of the disease can be slowed down but cannot be stopped completely. The right combination of antiretroviral drugs can slow down the damage that HIV causes to the immune system and delay the onset of AIDS.
What sort of care and treatment is available?
Treatment and care consist of a number of different elements, including voluntary counseling and testing, support for the prevention of onward transmission of HIV, follow-up counseling, advice on food and nutrition, treatment of STIs, management of nutritional effects, prevention and treatment of opportunistic infections, and the provision of antiretroviral drugs.
What are antiretroviral drugs?
Antiretroviral drugs are used in the treatment of HIV infection. They work against HIV infection itself by slowing down the reproduction of HIV in the body.
How do antiretroviral drugs work?
Inside an infected cell, HIV produces new copies of itself, which can then go on to infect other healthy cells within the body. The more cells HIV infects, the greater its impact on the immune system (immunodeficiency).
Antiretroviral drugs slow down the replication and, therefore, the spread of the virus within the body, by interfering with its replication process in different ways.
Nucleoside Reverse Transcriptase Inhibitors:
HIV needs an enzyme called reverse transcriptase to generate new copies of itself. This group of drugs inhibits reverse transcriptase by preventing the process that replicates the virus's genetic material.
Non-Nucleoside Reverse Transcriptase Inhibitors:
This group of drugs also interferes with the replication of HIV by binding to the reverse transcriptase enzyme itself. This prevents the enzyme from working and stops the production of new virus particles in the infected cells.
Protease is a digestive enzyme that is needed in the replication of HIV to generate new virus particles. It breaks down proteins and enzymes in the infected cells, which can then go on to infect other cells. The protease inhibitors prevent this breakdown of proteins and therefore slow down the production of new virus particles.
Other drugs that inhibit other stages in the virus's cycle (such as entry of the virus and fusion with an uninfected cell) are currently being tested in clinical trials.
Are antiretroviral drugs effective?
The use of ARVs in combinations of three or more drugs has been shown to dramatically reduce AIDS-related illness and death. While not a cure for AIDS, combination ARV therapy has enabled HIV-positive people to live longer, healthier, more productive lives by reducing viraemia (the amount of HIV in the blood) and increasing the number of CD4+ cells (white blood cells that are central to the effective functioning of the immune system).
For antiretroviral treatment to be effective for a long time, different antiretroviral drugs need to be combined. This is what is known as combination therapy. The term 'Highly Active Anti-Retroviral Therapy' (HAART) is used to describe a combination of three or more anti-HIV drugs.
If one drug is taken on its own, it has been found that, over a period of time, changes in the virus enable it to build up resistance to the drug. The drug is then no longer effective and the virus starts to reproduce to the same extent as before. If two or more antiretroviral drugs are taken together, the rate at which resistance develops can be reduced substantially. Usually, the combination consists of two drugs that inhibit the reverse transcriptase enzyme and one protease inhibitor.
Antiretroviral drugs should only be taken under medical supervision.
What is the current status of ARV treatment?
In developing countries, only about 15% of those in need are receiving anti-retrovirals, while there is near universal access in high-income countries.
Until recently, the high cost of the medicines, inadequate health care infrastructure and lack of financing has prevented wide use of combination ARV treatment in low- and middle-income countries, however, increased political and financial commitment in recent years, stimulated by people living with HIV, civil society and other partners has enabled a dramatic expansion of access to HIV therapy.
In 2002, 12 ARV medicines were included in the WHO Model List of Essential Medicines. These additions to the list were made after careful analysis of evidence of ARV efficacy in developing countries, which shows that these medicines can be used effectively and safely in these settings.
What kind of care is available when ARVs are not accessible?
Other elements of care can help maintain a high quality of life when ARVs are not available. These include adequate nutrition, counseling, prevention and treatment of opportunistic infections, and generally staying healthy.
What is PEP?
Post-exposure preventive (PEP) treatment consists of medication, laboratory tests and counseling. PEP treatment must be initiated within hours of possible HIV exposure and must continue for a period of approximately four weeks.
PEP treatment has not been proven to prevent the transmission of HIV. However, research studies suggest that, if the medication is initiated quickly after possible HIV exposure (ideally within two hours and not later than 72 hours following such exposure), it may be beneficial in preventing HIV infection.
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