Prepared by: Bratislav Prokić, July 2022
Review: Dr. Jovana Milić,
Metabolic clinic for HIV in Modena, Italy
When to start HIV therapy?
People with HIV should start taking antiretroviral therapy (ART) as soon as possible, immediately after the diagnosis of HIV infection.
What tests are done before prescribing HIV therapy?
Before starting antiretroviral drugs, blood tests are performed: a test that shows the degree of damage to the immune system by HIV (CD4+ T lymphocytes), as a test that measures the viral load in the blood (PCR HIV RNA), as well as tests for other sexually transmitted infections, including viral hepatitis, liver and kidney function tests, etc. Together with the initiation of antiretroviral therapy, it is desirable to perform a resistance test to antiretroviral drugs.
What does the CD4 test show?
The CD4 test shows the number of CD4+ T lymphocytes in a cubic millimeter of blood. The normal range of these cells is between 500 and 1500 in mm3. Because HIV uses these cells to reproduce, their total number declines over time. In order to determine the degree of damage to the immune system by HIV, the percentage of CD4+ T cells in relation to the total number of lymphocytes is also looked at.
What does the PCR test show?
The PCR test shows the viral load, i.e. viremia, by detecting the number of copies of viral particles in a milliliter of blood. This number is important for determining therapy, as well as for monitoring the further course of treatment. The goal is to reduce and maintain the number of viral copies at an undetectable level, below 50 copies/mL of blood.
Should I wait for the immunity, i.e. the number of CD4 cells, to drop before starting the treatment?
In the past, treatment was postponed until the number of CD4+ T lymphocytes in a microliter of blood fell below 350, then below 500. This approach was applied primarily because of the side effects of older drugs. Today, modern therapy is well tolerated and easy to take, which makes it possible to start treatment as soon as possible.
Why is it important to start HIV treatment as soon as possible?
Early initiation of antiretroviral therapy will preserve the immune system (of those diagnosed at an early stage), or give an already compromised immune system a chance to recover. This will reduce the risk of early death, from severe AIDS-related diseases, but also from chronic diseases.
INSIGHT START, study published in 2015, showed that people with HIV who start taking antiretroviral therapy early (immediately after diagnosis, regardless of the number of CD4+ T lymphocytes) drastically reduce the risk of AIDS, chronic diseases (cardiovascular diseases, chronic kidney failure, chronic liver failure and cancer) and death.i.
What is the life expectancy of a person with HIV?
The life expectancy of people living with HIV is close to the life expectancy of people without HIV, provided that HIV is diagnosed on time and treatment is started immediately, as well as that the person adheres to the prescribed medication regimen and has regular health checks.
Are HIV medications related to alcohol and drug use?
There are no interactions between alcohol and antiretroviral drugs (ART). Heavy drunkenness, however, can lead to missing a dose of medication. This can lead to treatment failure. Drugs can interact with HIV medications (most commonly with the drugs ritonavir and cobicistat) by reducing or enhancing the effects, which can lead to overdose.
Do HIV medications have anything to do with taking supplements?
Some supplements can significantly reduce the concentration of antiretroviral drugs in the blood and lead to therapy failure. A competent infectious disease specialist can determine whether there is an interaction between antiretroviral therapy and the supplement. Some antiretroviral drugs and supplements should be taken two hours apart. Taking supplements in large doses is harmful.
Are there cases in which a person with HIV should not start treatment?
In the case of using drugs for the treatment of certain opportunistic infections, the simultaneous use of antiretroviral therapy is not recommended. If a person with HIV faces psychological or social problems that make it difficult to take therapy regularly, it is necessary to find a solution in a conversation with an infectious disease specialist that will help the patient to start therapy as soon as possible.
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