Human Immunodeficiency Virus (HIV) is a lifelong disease for which there is no cure. However, with medication, HIV-positive individuals can manage their illness and extend their life expectancy to that of a standard lifespan. HIV is a life-threatening condition spread through bodily fluids that weakens a patient's immune system by destroying cells that fight disease and infection. It is transmitted via sexual intercourse, shared needles with an infected person, and during an infected mother's birth process or breastfeeding. It is important to get tested for HIV as soon as possible in order to receive effective treatment. If the virus is not controlled, one may get infections that a person with a healthy immune system is able to prevent. Modern advances now make it possible for a test to come back positive as early as one month. If a test comes back positive, the person will be referred to a medical provider that will order an HIV viral load to see if there is virus reproducing in the blood.
If a person receives an HIV diagnosis, the provider will test for CD4+ or T-cells, which determine the strength of the immune system. Most HIV-negative individuals have a CD4+ of 800-1200. As the amount of virus reproduces at a faster rate, the quicker the CD4+ declines. Once a person gets to less than 200 T-cells, they are considered as having AIDS (Acquired Immunodeficiency Virus) and may require antibiotic treatment to avoid infections such as pneumonia. In the past, people have had concerns about when to start therapy, mostly because of side effects, the amount of pills they would need to take, and the stigma of the disease. Advances in treatment now make is possible to take as little as one pill per day with much less side effects.
At New London Specialty Pharmacy, we provide an array of compliance and adherence programs which effectively promote a team environment between the pharmacists and the patient’s provider. We encourage patient compliance through educational materials, refill assessments, and counseling. Our pharmacists continuously strive to establish an integrated approach to the HIV patient that balances symptom management with adequate medication use.
1. What is the difference between HIV and AIDS?
a. HIV (Human Immunodeficiency Virus) is a virus, and AIDS (Acquired Immunodeficiency Syndrome) is a condition. HIV can be transmitted between people and can lead to AIDS. HIV lowers the immune system leading to more infections. AIDS is diagnosed when a person with an HIV infection gets an opportunistic infection or his or her immune cells called CD4 cells drop below a certain level.
2. Why is the prevalence of HIV increasing, but the incidence of HIV decreasing?
a. Prevalence stands for the percentage of a population with a disease state. The prevalence of HIV is increasing because HIV patients are living longer with the newer and more advanced medications. Incidence stands for the percentage of new cases of HIV in the population. The incidence of HIV is decreasing because more people are educated about safe practices of preventing HIV.
3. How does HIV impact the immune system?
a. Over time, HIV slowly destroys CD4 cells. The CD4 cell is a type of white blood cell that helps the body fight off infections. When a person’s viral load (the number of copies of the virus) increases, the number of CD4 cells decrease. With low CD4 cell levels, the patient is at a higher risk of developing infections.
4. What is the clinical course of HIV?
a. Within 2-4 weeks of infection, patients may start to experience flu-like symptoms with a rash. During this time, large numbers of the virus are being replicated in the body, which can cause the number of CD4 cells to drop rapidly. The patient is at the highest risk of transmitting HIV to other people in this early stage because of the high amount of HIV copies in the blood stream. After these 4 weeks, the body will start to respond and destroy the viral cells to reach a viral set point. While taking medications for HIV, the virus can enter a stage of latency for several decades. For patients not on medications for HIV, the latency stage will last for an average of 10 years. During the latency stage, the virus continues to replicate at low levels without producing symptoms. If a patient stops taking medications for HIV, then the virus will start to replicate at higher levels generating symptoms. Without any treatment, patients live for about 3 years on average.
5. How is HIV transmitted?
a. HIV can be transmitted through contact with HIV infected blood, semen, and vaginal fluids. HIV cannot be transmitted through sweat, tears, saliva, vomit, urine, and stool.
6. How can I practice safe sex to prevent the transmission of HIV?
a. Latex condoms should be used during sexual intercourse to prevent transmission of HIV. If a person has a latex allergy, polyurethane condoms should be used. Avoid natural membrane condoms, such as those made with lambskin. Water-based lubricants, such as K-Y jelly, should be used with condoms if a lubricant is desired, oil-based lubricants, such as Vaseline, should never be used with condoms because they can cause the condom to tear. The most effective method of preventing sexual transmission of HIV is abstinence.
7. How often should patients get tested for HIV?
a. Testing is part of every sexually active patient’s annual physical check-up during the ages of 13-64. People at high risk of HIV should test yearly with their healthcare provider, those at risk include men who have sex with men (MSM), persons with multiple sex partners, drug users, Hepatitis B patients, and incarcerated persons. Patients can also purchase OraQuick over-the-counter at the pharmacy to self-test with results recorded in 20 minutes. If a patient is concerned about being infected, it is recommended to schedule an appointment with a primary care physician as soon as possible.
8. What medications will prevent HIV transmission?
a. It is important to discuss with your healthcare provider if you are at risk of being exposed to HIV. Patients that might be candidates for pre-exposure prophylaxis (PrEP) are those that practice unsafe sex, syringe drug use or who have a HIV positive partner. If you meet any of the above criteria speak with your healthcare provider today on health alternatives to avoid contracting HIV.
9. How can I prevent the transmission of HIV after recent exposure?
a. Studies have shown that taking a medication called Truvada, a combination tablet of two different antiretroviral medications, will significantly reduce HIV transmission risks. Patients who have had recent exposure (maximum 72 hours) or believe they may have been exposed may be given a 28 day regimen of Truvada. See your healthcare provider for more information. However, even after 72 hours, it is essential for patients to report any forms of exposure to their healthcare provider.
10. When should medication therapy be started?
a. Guidelines recommend any patient infected with HIV be treated with antiretroviral medication. However, medication therapy should be strongly recommended if the patient is symptomatic, has a CD4 count less than 500 cells/mL, or is co-infected with hepatitis. Medications should only be started in patients that are willing to begin treatment. Poor adherence to HIV medications may increase the risk of resistance and treatment failure.
11. What is the goal of HIV treatment?
a. The goal is to reduce and maintain blood HIV RNA levels at undetectable levels, increase CD4 cell levels to greater than 500 cells/mm3, prevent the development of other diseases and infections, avoid transmitting HIV to others, improve quality of life, and extend life expectancy.
12. How do the HIV medications work?
a. There are many different classes of HIV medications that work in various ways. For example, HIV medications can prevent the virus from entering healthy cells, replicating inside of healthy cells, and integrating into the healthy cell’s DNA.
13. What if I am on a HIV medication that I do not like, can I stop taking it?
a. Persons infected with HIV should be on antiretroviral medication as prescribed. Taking antiretroviral medications not as directed or not at all can promote resistance making successful treatment difficult. With the recent boom in HIV research and drug development, many alternative medications exist that can be used to substitute a certain drug that is causing side effects. It is important for each patient to discuss any medication intolerances with their physician and pharmacist to allow for appropriate changes in therapy regimens.
14. What is resistance and how can I prevent it?
a. When HIV is resistant, the virus no longer responds to certain medications and the virus will start to multiply. HIV resistance can be prevented by taking medications as directed and avoiding contact with blood or genital secretions infected with HIV. Even if both persons are infected with HIV, it is still necessary to wear latex condoms and use clean needles to prevent co-mingling viruses and viral drug resistance.
15. Can other medications, prescription or over-the-counter, affect my HIV treatment?
a. Yes, HIV medications have many drug interactions and every new medication started should be discussed with your physician and pharmacist. Even alternative and herbal medicines can interact with your HIV medications; some examples are St. John’s Wort or Garlic tablets.