Treatment

Antiretroviral therapy (ART) consists of a combination of medications designed to manage HIV rather than curing or killing it. These drugs can inhibit the virus's replication, resulting in slowing the progression of HIV disease to AIDS and reducing the risk of opportunistic infections.

The main objective of the treatment is to increase survival, improve the quality of life, and limit HIV transmission by making the viral load very low (less than 200/mm³) which leads to an undetectable viral load, and HIV becomes untransmittable through exposure to fluids, pregnancy, and breastfeeding.

All people living with HIV should start the ART treatment as soon as possible no matter how healthy they feel. Delaying or missing the treatment gives HIV a chance to progress rapidly. Consistency in taking the treatment is essential for its success, to limit the progression of HIV, and to reduce the risk of creating drug resistance.

The treatment options include both an oral pill and an injectable treatment:

  • Pills are recommended for people who just initiated HIV treatment.

  • Injectable treatments are for people who have maintained an undetectable viral load for at least three consecutive months. Shots are given by a physician once per month or once every other month, depending on the treatment plan.

U=U

"Undetectable equals Untransmittable,"

has become a groundbreaking phrase that carries a message of hope and empowerment to individuals living with HIV. It signifies an important scientific discovery that has fostered a significant shift in the way we perceive and treat the virus.

Types of antiretroviral medications:

  • Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): work on blocking the 3rd stage of HIV’s life by targeting the action of an HIV protein called reverse transcriptase. It stops the 3rd step of HIV replication mentioned in the “How HIV attacks the immune system?” part.

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs): block the 3rd stage of HIV’s life by targeting the reverse transcriptase enzyme but in a different way. It works by binding directly to it, blocking the reverse transcription process.

  • Integrase inhibitors: This type of medication stops the 4th step, which is the integration, by stopping the work of the integrase enzyme, which stops the virus from entering the host cells.

  • Entry inhibitors (CCR5 inhibitors and fusion inhibitors): This drug blocks the first stage of HIV’s life. To enter the CD4 cells, HIV must bind to its receptors.  It works by preventing the virus from entering the human cells by binding to the CD4 T-cells’ receptors.

  • Protease inhibitors (PIs): Stage 6 is blocked by stopping the activity of the protease enzyme. This enzyme leads to mature and infectious versions of HIV after being released.

  • Attachment and post-attachment inhibitors: They prevent the binding (1st) stage. HIV has spikes on its surface, and these spikes need to connect to the CD4 receptor to get inside. This medication stops HIV from connecting to the CD4 receptor.

  • Booster drugs: work on boosting the effects of the antiretroviral drugs.

Factors to consider when choosing an HIV treatment plan:

  • Viral load and CD4: Help determine the adequate treatment plan.

  • Medical history: Pre-existing medical conditions such as heart disease.

  • Pregnancy: Check pregnancy status and implications of the treatment.

  • Potential drug interaction: Some medications or supplements may interact with the HIV treatment.

  • Side effects of ART: In case of intolerable side effects, the physician may change the medication.

  • Drug resistance: Some people are resistant to HIV treatment. A blood test for drug resistance is available if needed.

  •  Medication administration: Medications are either administered in a single pill or multiple pills, impacting the convenience of treatment.

  •  The type of HIV infection: HIV-1 and HIV-2 require different treatments due to their genetic differences.

Possible side effects:

The most common short-term side effects that typically go away within a few days or weeks of starting the medications are:

  • Skin Rash.

  • Diarrhea.

  • Nausea and Vomiting.

  • Headaches.

  • Dizziness.

  • Fatigue.

  • Insomnia / Difficulty sleeping.

  • Dry mouth.

Long-term side effects of HIV drugs:

  • Higher cholesterol or triglyceride levels can raise the risk of heart disease.

  • Hyperglycemia or high levels of glucose can cause diabetes.

  • Liver damage.

  • Kidney damage.

  • Lipodystrophy or body fat changes: losing fat, especially in the arms, legs, buttocks, or face, and gaining fat in the waist, stomach, or breasts.

  • Osteoporosis: weak bones.

  • Depression.

Some people may also experience hypersensitivity or allergic reactions. In these cases, and if the side effects are severe and/or persist, you should immediately contact your physician. The types of medications can be adjusted depending on the case.

A healthy lifestyle and a balanced diet rich in nutrients are crucial while on HIV treatments to provide the necessary conditions for the functions of the immune system work, to increase the effectiveness of the medication and side effects management, to prevent excessive weight gain or loss, and to enhance the overall quality of life.

Missing a dose or a shot

If an individual misses a dose of their HIV treatment:

  • The pill should usually be taken as soon as they remember unless their healthcare provider requests otherwise, and they should pursue taking the following pills at their scheduled time.

  • If an ART shot is missed, the healthcare provider should be contacted to schedule another appointment.

If you are concerned about forgetting to take your pill, here are some helpful ways to remember: 

  • Set a daily alarm on your phone or use a dedicated app for this purpose.

  • Place the pill in a spot you will definitely notice every day.

  • Link taking the pill to another daily routine or habit to help you remember.

Written by:

Lena Mhanna | Sexual health educator, nurse

Lena Mhanna, a passionate sexual health educator, with a bachelor's degree in Nursing Science is on a mission to break taboos, provide knowledge and empower individuals to enhance their sexual health and well-being.

Written by:

Cristel Lahoud | Sexual health educator, midwife

Cristel Lahoud is a sexual health educator at Marsa, holding a Bachelor's degree in Midwifery and currently pursuing a Master's degree in Clinical Psychology. Her profound dedication lies in raising awareness and promoting advocacy for both sexual and reproductive health.