There is no cure for human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS), but there are several types of medications that can prevent or slow the virus from progressing. Each medication stops HIV from replicating in different ways.
NYU Langone doctors prescribe a combination of at least three medications from two or more medication classes to avoid creating strains of HIV that are resistant to treatment. This is called antiretroviral therapy. Although a combination of medications is necessary, many patients are able to take a single daily pill that contains all three medicines.
HIV destroys CD4 cells, which are white blood cells that fight disease and infection. When the virus invades a CD4 cell, the cell becomes reprogrammed to create new copies of HIV. To do this, HIV needs the help of certain enzymes: reverse transcriptase, protease, and integrase. The major classes of HIV medications work by blocking these enzymes and preventing CD4 cells from turning into HIV replicators.
Non-nucleoside reverse transcriptase inhibitors stop HIV from multiplying. They prevent the enzyme reverse transcriptase from converting RNA to DNA, which is needed for HIV to infect CD4 cells.
Nucleoside reverse transcriptase inhibitors contain faulty versions of the building blocks that HIV uses to infect CD4 cells. When the HIV enzyme reverse transcriptase uses these faulty building blocks, HIV’s genetic material cannot be inserted into the healthy cell. Interrupting this process prevents the virus from replicating in CD4 cells.
Protease inhibitors block the production of protease, a protein that HIV needs to make copies of itself in a CD4 cell.
Integrase inhibitors are given to stop the production of integrase, another protein HIV uses to insert its genetic material into CD4 cells.
People using antiretroviral therapy take these medications for the rest of their lives. It is estimated that the lifespan of a person with HIV today is similar to that of a person who is not infected with HIV, as long as they consistently take their antiretroviral medications.
HIV infection and antiretroviral therapy may increase cardiovascular risk as a result of increased inflammation which may affect the amount of cholesterol in the blood. People on antiretroviral therapy can sometimes experience side effects, such as nausea, vomiting, diarrhea, or skin rashes. Doctors monitor you for these side effects, and can offer a different medication regimen if needed.
You doctor conducts blood testing every three months to measure your CD4 levels and viral load, which are used to determine the amount of HIV in the blood. The goal of treatment is to return CD4 levels to normal, improving the immune system’s ability to fight infection, and to suppress the amount of virus in the blood to the point where it can’t be detected by a lab test.
After HIV levels are undetectable, the doctor continues to use blood tests to check your viral load levels every three months. When HIV levels are undetectable in the blood, HIV cannot be transmitted to others through sex. However, it is still possible to transmit HIV in other ways, such as needle sharing or breastfeeding. Even with an undetectable viral load, this doesn’t mean the HIV infection is cured. Medication must be continued to keep the viral load at an undetectable level.
NYU Langone doctors also treat any problems related to HIV infection, such as anemia, which is caused by low levels of red blood cells, and dangerously low white blood cell levels, which may lead to infection or cancer.
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