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NHS Choices Condition

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If you are diagnosed with HIV, you will be referred to a HIV clinic. You will also be offered counselling.

As part of your treatment, you will undergo regular blood tests. The tests are used to measure two things:

  • your CD4 count - which is the number of CD4 cells in your blood, and
  • viral load - which is the amount of HIV in your blood.

These tests allow the staff at the HIV clinic to see how far the disease has progressed, and the likelihood that will you develop an infection.

The implications of different CD4 counts are explained below.

  • A CD4 count of 500 or above means that there is no risk of infection.
  • A CD4 count of between 200 and 500 means that there is a small risk of infection, particularly from tuberculosis (TB).
  • A CD4 count of less than 200 means that there is high risk of serious infection.

The viral load will be regularly measured in order to show whether the medicines that are being used to treat HIV are working effectively. A high viral load may mean that you need a new combination of medicines.

Both the CD4 count and viral load can fluctuate over time, so one high or low reading does not automatically mean that your condition has got worse. The general trend of your CD4 count and viral load over time is more important in tracking the progression of the condition.

Highly active antiretroviral therapy (HAART)

There is no cure or vaccine for HIV and researchers believe it will be many years, if not decades, before either is found. However, special medicines that are used in what is known as highly active antiretroviral therapy (HAART) has proved remarkably successful in slowing the progression of the condition and prolonging life.

Researchers are confident that continuing improvements in therapy will mean that a person with HIV will have the same lifespan as somebody who does not have the condition

The therapy involves using a combination of medicines. This is because HIV can quickly adapt and become resistant to one single medicine. Therefore, a combination of different medicines is required.

It is normally recommended to begin active antiretroviral therapy (HAART) if:

  • your CD4 count drops below 350,
  • you have symptoms of HIV or AIDS (regardless of CD4 count),
  • you have hepatitis B and need treatment for it,
  • you are pregnant, to prevent your unborn child from becoming infected with HIV.

If treatment is not started, your condition will be monitored and regular CD4 counts will be taken.

There are many different types of medicine that can be used as part of your therapy. They include:

  • nucleoside reverse transcriptase inhibitors (NRTIs or 'nukes'),
  • non-nucleoside reverse transcriptae inhibitors (NNRTIs or 'non-nukes'),
  • protease inhibitors,
  • fusion inhibitors, and
  • integrase inhibitors.

These medicines work in different ways, but they are all designed to interrupt the reproductive cycle of the virus in order to slow down its spread and protect your immune system.

Most people with HIV are recommended to take two types of medication from the NRTIs class, plus a medicine from another class.

The goal of treatment is to find the best combination of medicines, while minimising any side effects.

Side effects
In some people, the medicines that are used to treat HIV will cause side effects. However, the side effects tend to improve after a few weeks as your body gets used to the medicines. Common side effects of HIV medication include:

  • nausea,
  • tiredness,
  • diarrhoea,
  • skin rashes,
  • mood changes, and
  • gaining fat on one part of your body while losing it on another (lipodystrophy).

Protease inhibitors have been known to increase the levels of cholesterol and sugar in the blood, which can lead to the hardening of your arteries (arteriosclerosis). Arteriosclerosis will increase your chances of developing a cardiovascular disease, such as heart disease or stroke.

Eating a healthy diet, taking regular exercise and not smoking will help to reduce the risk of developing arteriosclerosis. You may also be given special medicines to help further reduce the risk. These include medicines known as statins that can reduce the level of cholesterol in your blood.

Some anti-HIV medicines have been known to cause damage to the nerves in the hands and feet, a condition known as peripheral neuropathy. This can cause your hands and feet to feel numb, or tingly. You should report any such symptoms straight away as your treatment plan will need to be changed in order to prevent further nerve damage.

If you find that the side effects from HIV treatment are adversely affecting your quality of life, you should inform the staff at your HIV clinic. It may be possible to change your medicines, or other medicines may be available that can relieve any side effects.

The medicines used to treat HIV are only effective when taken exactly as prescribed. Missing even a few doses will increase the risk of your treatment not working.

Sticking to your treatment plan is known as adherence. To adhere to treatment you need to:

  • take the medicine at the recommended time,
  • take the recommended dose, and
  • follow all instructions regarding diet - for example, some medicines you will be given should only be taken on an empty stomach, while others need to be taken with food.

You will need to develop a daily routine in order to fit your treatment plan around your lifestyle. The staff at your HIV clinic will be able to provide you with advice and support.

You should remember that many of the medicines that are used to treat HIV can react in unpredictable ways if you take other types of medicines. These include herbal remedies such as St John's Wort, recreational drugs such as cocaine, and over-the-counter medicines.

You should always check with your clinic staff or your GP before taking any other medicines.

Post Exposure Prophylaxis (PEP)

It is sometimes possible to halt the development of HIV in the first 72 hours after infection. This is known as post exposure prophylaxis (PEP). PEP involves taking anti-HIV medicines for four weeks.

PEP is often used when a person knows that they have definitely been exposed to the HIV virus. For example, if they were having sex with someone who they knew had the HIV virus and the condom broke, or they were accidentally stabbed with an HIV-infected needle.

However, PEP is not guaranteed to work and the medicines that are used cause some unpleasant side effects, such as nausea, vomiting, diarrhoea and headaches.

If you are concerned that you have been exposed to the HIV virus, you should immediately contact your local accident and emergency department or GUM (genito-urinary or sexual health) clinic.

The Terence Higgins Trust is an HIV charity that can advise you about where you can obtain PEP.

view information about HIV on www.nhs.co.uk »

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