Treatment

Since 1995, there has been a tremendous decrease in HIV — and AIDS-related deaths, primarily because of the development of highly active antiretroviral therapy (HAART; Katz et al., 2002). HAART is the combination of three or more HIV drugs, often re­ferred to as “drug cocktails.” This development, in conjunction with the development of

 

ELISA (enzyme-linked immunoabsorbent assay) The screening test used to detect HIV antibod­ies in blood samples.

 

Western Blot A test used to confirm a positive ELISA test; more accurate than the ELISA test, but too ex­pensive to be used as the primary screening de­vice for infection.

 

false negative A negative test result that occurs in a person who is positive for the virus.

 

false positive A positive test result that occurs in a person who is negative for the virus.

 

ReviewQuestion Explain how a person is diagnosed with HIV infection.

 

highly active antiretroviral therapy (HAART) The combination of three or more HIV drugs.

HIV RNA testing (which allows healthcare providers to monitor the amount of virus in the bloodstream), has allowed for better control of HIV and has slowed the disease progression. However, HAART therapy is the standard of care only in North America and Europe, where approximately 1.6 million of the 38 million HIV-positive people live (D. Brown, 2002b). Fewer than 1% of HIV-positive men and women in sub-Saharan Africa are on HAART therapy. We will talk more about cross-cultural differences in treatment shortly.

The life expectancy of children infected with HIV at birth has increased substan­tially since the introduction of highly active antiretroviral therapy (“Trends in HIV/AIDS Diagnoses,” 2005). Whereas in the past the infection progressed rapidly un­til death, today children are surviving with HIV longer than earlier in the epidemic (Abrams et al., 2001).

Before starting treatment for HIV infection, a person should be given both a viral load test and CD4+ T cell count. These tests can determine how much HIV is in a per­son’s system and also estimate the T-helper white blood cell count (which can show how well a person’s immune system is controlling the virus). A baseline CD4+ cell count will also give a healthcare provider a starting measure to compare to later viral load estimates after a person has started drug therapy. This will enable the healthcare provider to see whether the drug combinations are effective.

HAART therapy for HIV is complicated and can involve taking 25 or more pills a day at various times during the day. Some drugs must be taken on an empty stomach, while others must be taken just after eating. Some people on HAART therapy miss pills due to oversleeping, traveling, feeling too sick, or simple forgetting (Chesney, 2000). Once a person starts this type of drug therapy, it is very important that the dosages are taken every day at the same time (unlike other medications that require an 80% adher­ence, HIV drugs require a near-perfect adherence to dosing schedules; Mannheimer et al., 2002). Missed dosages can cause a drug resistance, which will destroy the drug’s ef­fectiveness. A missed dose could also cause the virus to survive and mutate into a resis­tant strain that will not respond to drug therapy. Some people on HAART therapy set timers to remember to take their pills at the right time. HAART therapy is also expen­sive, usually ranging from $10,000 to $15,000 a year (Cox, 2000). A person who begins drug therapy will most probably continue it for his or her entire life.

There are side effects to HAART therapy. These include problems such as fatigue, nausea, fever, nightmares, headaches, diarrhea, changes in a person’s fat distribution, el­evated cholesterol levels, the development of diabetes, decreased bone density, liver problems, and skin rashes. Two to eight weeks after starting HAART therapy, a person should have his or her viral load test redone. This will enable a healthcare provider to see how effective the drugs are. After this initial test, a person should have a viral load test every 3 to 4 months and a CD4+ T cell count every 3 to 6 months to make sure the drugs are still effective. If the viral load is still detectable 4 to 6 months after starting treatment, the drug therapy should be changed. How fast the viral load decreases de­pends on several factors, including baseline CD4+ T cell count, whether the person has any AIDS-related illnesses, and how closely the person has followed the drug therapy protocol.

Many healthcare providers believe that after a patient has been diagnosed with HIV, it is important that he or she receive psychological counseling to provide information on the virus, promote a healthier lifestyle, reduce the risk of transmission to others, help him or her learn coping strategies, and abstain from high-risk behaviors. Without this intervention, it is possible that people who are diagnosed with HIV will become de­pressed and may even attempt suicide (Ickovics et al., 2001).

Research has found that depressed men in the early stages of AIDS infection suffer a more rapid decline in their physical health and die earlier than do nondepressed men (Antoni et al., 2002). Being optimistic, having social support, and engaging in a diver­sion of attention (e. g., “keeping busy”) have also been found to confer a mental health benefit on HIV-positive men and women (J. M. Johnson & Endler, 2002). Studies have shown that friends generally provide more social support to people with HIV/AIDS than do family members (Serovich et al., 2000). This is especially true for those who became infected with HIV through same-sex activity or drug use.

Question: What are the chances of actually finding a cure for AIDS?

The current thinking is that there will never be a cure for AIDS. Because HIV has the ability to become latent in the cells of the body, total eradication may be impossible as well. Many research studies are being done all over the world, and scientists are searching for vac­cines, treatments, and cures. Because the virus is so complex and because it constantly reproduces and changes itself, finding a cure is very difficult. There is a much greater chance of finding a vaccine to immunize people against AIDS than of finding a cure for people who are already infected.

Although HAART therapy has significantly decreased deaths from HIV/AIDS, these effects are less pronounced in elderly people. Today those who are diagnosed with HIV after age 60 have a shorter survival rate than those who are diagnosed earlier (Butt et al., 2001). These elderly HIV-positive patients are also more likely to be male and African American or Hispanic, and the majority are men who are having sex with men or intravenous drug users. There are many reasons why survival times might be shorter in elderly patients, including the belief that HIV doesn’t occur in older people or a lack of education about symptoms or the disease, all of which can lead to failure to be tested or seek care.

Question: If two people are free of the AIDS virus and have anal sex, could they then get AIDS from each other?

If neither partner is infected with HIV, there is no way they can trans­mit the virus to each other—or to anyone else—regardless of their sexual behaviors.