HIV / AIDS: Combination Antiretroviral Therapy

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HIV / AIDS: Combination Antiretroviral Therapy
HIV / AIDS: Combination Antiretroviral Therapy
Video: HIV / AIDS: Combination Antiretroviral Therapy
Video: Impact of early initiation of combination antiretroviral therapy on measures of virus in ... 2023, February
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HIV / AIDS: Combination Antiretroviral Therapy

Once the diagnosis of “HIV-positive” has been made, a detailed discussion with the treating doctor follows. The person concerned is informed about treatment options and protective measures in order to avoid HIV transmission. Additional special examinations are necessary: ​​The virus load and the state of the immune system are examined by means of a blood sample, and it is determined whether there are any accompanying diseases. For this purpose, the patient is referred to an HIV treatment center.

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  • Examination of the need for therapy
  • What is the ART?
  • When is therapy started?
  • Advantages of starting therapy early
  • How is treatment and care carried out?
  • What accompanying measures are being taken?
  • Whom can I ask?
  • How are the costs going to be covered?

Examination of the need for therapy

HIV practitioners worldwide agree that HIV therapy should be initiated as soon as possible after diagnosis, in accordance with the recommendations of the WHO. Therapy is started after a detailed consultation with the patient. Regular controls of HIV-relevant laboratory values ​​are required with and without therapy.

What is the ART?

The drug therapy is called combination antiretroviral therapy (ART). Usually three different active ingredients are combined for this combination therapy. In order to choose the optimal combination for the patient, a check is made prior to treatment to determine which substances the HIV virus might be resistant to. The first drug treatment at the beginning of HIV therapy is called initial therapy. Its goal is to suppress the HIV virus replication as well as possible. If the initial therapy is poorly tolerated or is no longer sufficiently effective due to the development of resistance, intolerance or ingestion errors (e.g. poor adherence to therapy), a switch to other active ingredients takes place after a resistance test in the blood. The possibilities for this are limited, however.

The following drug classes are available for the treatment of HIV infection:

  • Nucleoside / nucleotide analogs
  • Non-nucleoside reverse transcriptase inhibitors
  • Protease inhibitors
  • Integrase inhibitors
  • CCR5 inhibitors

These drugs inhibit the virus from multiplying in several ways.

When is therapy started?

A good time to start therapy is when the immune system can still recover and the HI virus or HIV-associated diseases have not yet caused serious damage to the organ system.

However, therapy can be started in any phase of the HIV / AIDS disease:

  • If HIV transmission was only a few hours, days or weeks ago, the patient is in the phase of acute HIV infection with a high viral load.
  • If HIV transmission was more than six months ago, the patient is in the stable phase of chronic HIV infection. Typical for this phase are a relatively low virus load and a well-functioning immune system.
  • If the HIV transmission was already several years ago and there are clear signs of a breakdown of the immune system (e.g. frequent infections, attacked organ systems etc.), it is called AIDS.

Advantages of starting therapy early

Timely initial therapy has positive effects on the state of health of the HIV patient. The following effects occur:

  • Maintaining a high CD4 + cell count and possibly avoiding irreparable damage to the immune system,
  • Lowering the risk of HIV-associated complications (e.g. tuberculosis, non-Hodgkin lymphoma, Kaposi's sarcoma, peripheral neuropathy, HPV-associated malignancies and HIV-associated emotional or intellectual impairments) and
  • greatly reducing the risk of HIV transmission.

Most HIV practitioners today recommend starting HIV therapy regardless of laboratory results as soon as the patient is ready. The current treatment regimens are simple, highly potent and relatively few side effects. For this reason, well over 90 percent of all patients in care throughout Austria are under antiretroviral therapy.

Note Resistance to HIV drugs can occur if they are not taken regularly and the concentrations of the active ingredients are not above a certain minimum therapy level. Resistant viruses severely limit the therapy options and worsen the individual prognosis.

How is treatment and care carried out?

The HIV-experienced medical examiner accompanies and supports the patient from the start. In HIV treatment centers in hospitals, there are doctors who specialize in drug management, well-trained nursing staff and, among other things, psychological support. Treatment can be carried out on an outpatient basis or - if necessary - temporarily as an inpatient. HIV therapy is also possible with specialized resident doctors in specialized practices.

What accompanying measures are being taken?

When starting a combination antiretroviral therapy, the patient is first informed in detail about all advantages and disadvantages. The willingness to take the medication regularly and completely is a decisive prerequisite for the success of the treatment.

Medical checks are carried out to accompany the antiretroviral combination therapy. If the patient is well tolerated, checks with blood tests are scheduled every eight to twelve weeks. It is checked whether the treatment significantly reduces the virus load and strengthens the immune system (increase in CD4 + helper lymphocytes) and how the medication affects the blood count or other organ systems.

Antiretroviral drugs can cause undesirable side effects. It is important that these are recognized early and avoided (e.g. by changing the drug combination). Possible side effects of HIV therapy include:

  • Nausea,
  • A headache,
  • Fatigue,
  • Diarrhea,
  • Rashes,
  • Dizziness,
  • Sleep disorders and
  • Increase in blood lipids.

At the beginning of ART there can be a strong activation of the immune system. For example, fever and / or skin rashes can occur. A reactivation / activation of certain latent (dormant) infections (e.g. TBC or hepatitis B) are also possible. In addition, autoimmune diseases (e.g. Guillain-Barré syndrome, systemic lupus erythematosus - SLE) or cancer (e.g. Kaposi's sarcoma, non-Hodgkin lymphoma) can develop. This phenomenon is called Immune Reconstitution Syndrome (IRS) or Immune Reconstitutional Inflammatory Syndrome (IRIS). The IR (I) S occurs in about ten to 20 percent of those infected with HIV.

Whom can I ask?

Treatment of HIV / AIDS is possible in the following facilities:

  • Hospital (ideally with an HIV treatment center),
  • Specialized doctor in private practice.

Further information can be found under Treatment Centers & Doctors.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles

People with HIV infection are currently exempt from the prescription fee.

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