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Acquired Immune Deficiency Syndrome

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Acquired Immune Deficiency Syndrome (AIDS)
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There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life for those who have already developed symptoms.

 

Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. This is measured by the viral load (how much virus is found in the blood). Preventing the virus from replicating can improve T-cell counts and help the immune system recover from the HIV infection.

 

HAART is not a cure for HIV, but it has been very effective for the past 12 years. People on HAART with suppressed levels of HIV can still transmit the virus to others through or by sharing needles. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mm3), life can be significantly prolonged and improved.

 

However, HIV may become resistant to HAART, especially in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether an HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each person, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and before starting therapy.

 

When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs on the market for treating drug-resistant HIV.

 

Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are:

 

  • Collection of fat on the back ("buffalo hump") and abdomen

  • General sick feeling (malaise)

  • Headache

  • Nausea

  • Weakness

 

When used for a long time, these medications increase the risk of heart attack, perhaps by increasing the levels of fat and glucose (sugar) in the blood.

 

Any doctor prescribing HAART should carefully watch the patient for possible side effects. In addition, routine blood tests measuring CD4 counts and HIV viral load should be taken every 3 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the amount of HIV virus in the blood to a level where it cannot be detected.

 

Other antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen) and filgrastim (G-CSF) are sometimes used to treat anemia and low white blood cell counts associated with AIDS.

 

Medications are also used to prevent opportunistic infections (such as Pneumocystis jiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.

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