Back in the mid-1980s — before doctors really knew what caused acquired immune deficiency syndrome (AIDS) and had even less of an idea how to treat it — an AIDS diagnosis was considered a death sentence. Today, there are many different medications that work against human immunodeficiency virus (HIV), the virus that causes AIDS. If you’re infected with HIV but don’t yet have AIDS, anti-viral medications can help you keep the disease from progressing. If you already have AIDS, the medications can help you stay alive longer by keeping your immune system as strong as possible.
Do I need to take medication if I’m HIV-positive?
Not everyone who is infected with HIV needs to start taking medications right away. For one thing, the drugs are expensive and can cause significant side effects, so doctors may not prescribe them unless they think patients can really benefit. Guidelines released by the International AIDS Society in 2008 recommend that doctors consider prescribing medications to all patients with a CD4 count — a measure of certain immune cells — below 350 (This was instead of the previous cutoff level of 200). If you’re still in overall good health, and your CD4 cell count is still above 350 (per microliter), you may not need HIV medication for now. However, your doctor will want to see you regularly, probably at least every three months to check your test results.
On the other hand, there is new evidence that starting treatment even earlier (CD4 counts between 350 and 500) can lead to 70 percent higher long-term survival rates. Early treatment may not be right for everyone, though because once you start taking HIV drugs, you must stick to your treatment strictly — and indefinitely.
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What are the different types of HIV drugs?
The drugs used to treat HIV come in several different varieties. Most of them work by making it difficult for the HIV virus to make copies of itself, an approach called anti-retroviral therapy (ART). Different types of drugs will interrupt the copying process in different ways. Many people take a combination of three or more drugs — also called a drug cocktail or highly active antiretroviral therapy (HAART) — to fight the infection on more than one front. Here’s a look at the major types of HIV medications:
- Fusion inhibitors: When HIV enters the body, it targets a certain type of immune cell called a T lymphocyte. The virus binds with CD4, a molecule on the surface of CD4-positive T lymphocytes. Once it binds, the virus fuses with the cell membrane and releases its genetic information into the cell. Fusion inhibitors block this process. Examples include Fuzeon (enfuvirtide) and Selzentry (maraviroc). The first fusion inhibitor was approved in 2003. These are relatively new drugs and they must be injected, so they are not a first-line treatment.
- Reverse transcriptase inhibitors: HIV is a retrovirus. Its genetic material is RNA (a single-stranded form, which is short-lived in our bodies) instead of DNA, a double-stranded (and very stable) form found in our own cells. In order to stay in our cells and use our cell’s machinery to replicate, the virus needs to convert its RNA into DNA. It does this with an enzyme called reverse transcriptase.
There are two types of reverse transcriptase inhibitor drugs:
