What are HIV and AIDs?

HIV stands for human immunodeficiency virus. This is a virus in the group of viruses called retroviruses. HIV destroys cells in the body called CD4 T cells. CD4 T cells are a type of lymphocyte (a white blood cell). These are important cells that protect the body against various bacteria, viruses and other germs. HIV actually multiplies within CD4 cells. HIV cannot be destroyed by white blood cells, as it keeps on changing its outer coat, so protecting it.

AIDS stands for acquired immunodeficiency syndrome. This is a term which covers the range of infections and illnesses which can result from a weakened immune system caused by HIV.

It is important to remember that when you are first infected with HIV you do not have AIDS. There is usually a time lag of several years between first being infected with HIV and subsequently developing infections and other AIDS-related problems. This is because it usually takes several years for the number of CD4 T cells to reduce to a level where your immune system is weakened.

HIV is now a treatable medical condition and most treated people remain fit and well.

This leaflet is a brief overview of medicines that are used to treat HIV and AIDS. For more information see separate leaflet called HIV and AIDS and the information resources listed below.

What are medicines for HIV and AIDS and how do they work?

Medicines for HIV and AIDS are sometimes called antiretroviral medicines. There are six different types of these medicines available to prescribe in the UK; they include:

• Nucleoside or nucleotide reverse transcriptase inhibitors - abacavir, didanosine, emtricitabine, lamivudine, stavudine, and tenofovir.
• Non-nucleoside reverse transcriptase inhibitors - efavirenz, etravirine, and nevirapine.
• Protease inhibitors - atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, and tipranavir.
• Integrase inhibitors - raltegravir.
• Fusion inhibitors - enfuvirtide.
• CCR5 antagonists - maraviroc.

Antiretroviral medicines work by stopping the HIV from making copies of itself. The amount of virus in your body (viral load) is decreased. This gives your immune system some time to become strong again and allows your body to make more CD4 T cells. The aim of treatment is to reduce the viral load to very low levels for as long as possible, and to increase the number of CD4 T cells to a normal level. This in turn means you are less likely to get infections.

The medicines in each class work in slightly different ways, but all work to stop the HIV from replicating itself. They work best when they are prescribed in combination.

If I have HIV or AIDS when is treatment usually started?

As a general rule, antiretroviral medicines are usually started if:

• Infections or other AIDS-related problems develop; or
• Your CD4 T cells fall below a certain level (around 350 cells per cubic millimetre of blood or less) - even if you do not have symptoms. The exact level when treatment is started depends on various factors which your doctor will discuss with you. These include any symptoms present and the rate of decline of the CD4 T cells.

The treatment of HIV is a rapidly changing area of medicine. Trials are underway to assess whether antiretroviral medicines should be started earlier in people who have no symptoms, even as early as when first infected with HIV. The trials aim to show whether there are benefits from treatment before symptoms develop, which outweigh the risk of side-effects from the medicines.

Which antiretrovirals are usually prescribed?

The choice of medicines is considered and chosen for each individual patient. The treatment for HIV can be complicated, as it involves taking many different medications. A team of healthcare professionals is usually involved in looking after you and giving you your treatment.

As discussed above, these medicines work best in combination. Taking three or more antiretroviral medicines at the same time, each attacking HIV at different points in its cycle of replication, is more effective than one or two medicines alone. Taking a combination of different medicines also reduces the risk that the virus will become resistant to any individual medicine. In 2008, the first one pill a day treatment was launched. Each pill contains three different medicines. This is popular, as it is convenient to take and has few side-effects.

In general, most guidelines recommend that you start with either:

• Two nucleoside or nucleotide reverse transcriptase inhibitors plus a non-nucleoside reverse transcriptase inhibitor (this regimen is usually tried first); or
• Two nucleoside or nucleotide reverse transcriptase inhibitors plus a protease inhibitor boosted with low doses of ritonavir. This treatment regimen is usually reserved for people who have resistance to the above regimen, women who want to become pregnant, or anyone with psychiatric illness.

When taking medicines for HIV and AIDS

Some important considerations are:

• Adherence - taking your medicines exactly as prescribed.
• What to do if you miss a dose.
• Dietary restrictions.
• Regular blood tests.
• Taking other medicines.

Adherence - taking your medicines exactly as prescribed

It is vital to take the medication regularly and exactly as prescribed, to maintain success and to help to prevent the virus from becoming resistant to the medicines. Even if you miss one or two doses, the virus can become resistant to treatment.

What to do if you miss a dose

If you forget to take a dose, take your medicines as soon as you remember. However, if you remember just as you are about to take your next dose, do not take two doses at the same time to make up for the missed dose. If in doubt, speak to your pharmacist or doctor.

If you are regularly forgetting to take your medicine, talk to your doctor or pharmacist; there may be other combination medicines that are more suitable for you.

Regular blood tests

You are likely to have regular blood tests to monitor how well these medicines are working. You will usually have a CD4 T-cell count and a viral load blood test before you start treatment. This is called a baseline measurement. After starting treatment, your doctor will usually measure your viral load and CD4 T-cell count after one month later, and then about every three months thereafter. If your treatment is effective then your viral load will decrease and your CD4 T cells will increase.

You may need more blood tests if you feel unwell or develop symptoms such as an infection.

Taking other medicines

Quite a few medicines that you may be prescribed for other conditions or that you can buy from pharmacies or supermarkets can interfere with HIV medicines. This includes herbal medicines. Always ask your pharmacist or doctor before taking any new medicines. For more information see the leaflet that came with your medicine.

What are the possible side-effects?

The side-effects for most HIV medicines are usually mild and often go away after a few weeks. Common side-effects include nausea (feeling sick), vomiting and headache. If these side-effects do not go away, your doctor can prescribe some other medicines to help with these problems. If this does not help, your doctor may change your medicines.

Other less common side-effects include:

• Damage to the liver, kidneys, or pancreas.
• Skin rash.
• Dry skin, nail problems, hair loss.
• Peripheral neuropathy (damage to the nerves).
• Fat loss (lipoatrophy).
• Fat accumulation.
• Increased blood-sugar levels and risk of type 2 diabetes.

See the leaflet that comes with your particular brand for a full list of possible side-effects and cautions.

What is the usual length of treatment?

Once you have started treatment you will need to take these medicines for the rest of your life. This is in order to keep your immune system healthy and to prevent you from getting infections.

How well do medicines for HIV and AIDS work?

Although these medicines do not cure HIV, they slow the progression of HIV to AIDS. They are effective at allowing people with HIV to live their lives as normally as possible. Since the introduction of medicines to treat HIV, the death rates from AIDS has reduced dramatically. Newer medicines are more effective than medicines used in the past.

What happens if I do not take HIV medicines?

If you have HIV and do not take HIV medicines, eventually - typically, over a number of years - your viral load increases and the number of CD4 T cells decreases significantly. Your immune system becomes very weak. This means that you are open to getting infections and your body is unable to fight the infection. These infections can become serious and overwhelming for your body and you are likely to die.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:

• The side-effect.
• The name of the medicine which you think caused it.
• Information about the person who had the side-effect.
• Your contact details as the reporter of the side-effect.

It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.

Further help and information

HIV i-Base

4th Floor, 57a Great Suffolk Street, London, SE1 0BB
Tel: 020 7407 8488 or Treatment phoneline: 0808 800 6013, Mon, Tues, Wed 12-4 pm
Web: http://i-base.info/home
HIV i-Base is a treatment activist group, HIV-positive-led and committed to providing timely HIV treatment information to HIV-positive people and to healthcare professionals.

National Aids Trust

New City Cloisters, 196 Old Street, London, EC1V 9FR
Tel: 020 7814 6767 Web: www.nat.org.uk
Promotes a wider understanding of HIV and AIDS, develop and support efforts to prevent the spread of HIV and improve the quality of life of people affected by HIV and AIDS.

Terrence Higgins Trust

314-320 Grays Inn Road, London, WC1X 8DP
Helpline: 0845 1221 200 Web: www.tht.org.uk
A national HIV and sexual health charity. Their helpline offers information and support to anyone living with HIV, affected by HIV indirectly or concerned about their sexual health.

Aidsmap Website

Web: www.aidsmap.com
A comprehensive web-based resource on HIV and AIDS-related matters.

Patient.co.uk

Lists several other HIV/AIDS support organisations.
Web: www.patient.co.uk/displayCategory/16777265

Sexual Health Videos from NHS Choices

Web: www.nhs.uk/video/Pages/medialibrary.aspx?Tag=Sexual+health
Includes videos specifically about HIV and AIDS. For example, a video called 'HIV Real Story' is about Mick who was infected with HIV, hepatitis B and hepatitis C through contaminated blood products 25 years ago. He describes the effects and side-effects of treatment, how he copes with the infection, and how attitudes towards HIV have changed.