In July 2010 the Centers for Disease Control and Prevention estimated that 1 million people in the United States were living with HIV/AIDS. Whereas infection with the human immunodeficiency virus was once untreatable due to lack of effective medications, the development of several classes of antiretroviral drugs has turned the tide on the long-term prognosis for people living with HIV/AIDS. Preservation of the immune system, prevention of opportunistic illnesses and effective treatment of infections remain the primary goals of HIV/AIDS treatment.
Combination Antiretroviral Therapy
Combination therapy with two or three drugs from different classes of antiretroviral medications is the standard of care for the treatment of people living with HIV/AIDS, according the 2009 U.S. Department of Health and Human Services HIV-1 treatment guidelines.
The most commonly prescribed classes of antiretroviral medications used for the treatment of HIV/AIDS include protease inhibitors, nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and integrase strand transfer inhibitors. Suppression of HIV to an undetectable level in the blood indicates antiretroviral treatment effectiveness. Because HIV persists in the immune system despite being undetectable in the blood, treatment with combination antiretroviral therapy continues for the duration of a person's life.
For people beginning combination antiretroviral therapy, the 2009 Department of Health and Human Services treatment guidelines recommend a combination of two different nucleoside reverse transcriptase inhibitors plus a third drug selected from one of the other three classes of anti-HIV medications.
Preventive Therapy
HIV infects and kills immune system cells called CD4+ cells. When the number of CD4+ cells decreases, the body becomes vulnerable to overwhelming infections. Doctors treat people with HIV infection and a low CD4+ count with medications to prevent these infections, known as opportunistic infections or AIDS-defining illnesses.
The CDC recommends daily treatment with the antibiotic trimethoprim-sulfamethoxazole for the prevention of Pneumocystis pneumonia and toxoplasmosis. Azithromycin or clarithromycin is recommended to prevent infection with Mycobacterium avium, an organism related to the tuberculosis bacterium. Other antibiotics may be used to prevent various opportunistic infections in people with specific risk factors.
Opportunistic Infection Treatment
The development of an opportunistic infection signifies substantial weakening of the immune system and marks the transition from HIV infection to AIDS. Guidelines developed by the CDC in collaboration with the National Institutes of Health and the HIV Medicine Association of the Infectious Diseases Society of America provide recommendations for the treatment of a variety of opportunistic infections.
Treatment of an opportunistic infection typically involves the use of an antibacterial, antifungal or antiparasitic drug along with other medications to suppress or cure the infection. The choice of medications depends on the type and locations of the infection. Certain infections require lifelong treatment.
References
- Centers for Disease Control and Prevention: HIV and AIDS in the United States
- Department of Health and Human Services: Guidelines for the Use of Antiretroviral Agents in HIV-1-infected Adults and Adolescents
- CDC Morbidity and Mortality Weekly Report: Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents
