AIDS Health Article

Treatment

Since the early 1990s, several drugs to fight both the HIV infection and its associated infections and cancers have become available, including:

• Reverse transcriptase inhibitors: They interrupt the virus from making copies of itself. These drugs are AZT (zidovudine [Retrovir]), ddC (zalcitabine [Hivid], dideoxyinosine), d4T (stavudine [Zerit]), and 3TC (lamivudine [Epivir]).
• Nonnucleoside reverse transcriptase inhibitors (NNRTIS): These medications are used in combination with other drugs to help keep the virus from multiplying. Examples of NNRTIS are delavirdine (Rescriptor) and nevirapine (Viramune).
• Protease inhibitors: These medications interrupt virus replication at a later step in its lifecycle. These include ritonavir (Norvir), a lopinavir and ritonavir combination (Kaletra), saquinavir (Invirase), indinavir sulphate (Crixivan), amprenavir (Agenerase), and nelfinavir (Viracept). Using both classes of drugs reduces the chances of developing resistance in the virus.
• Fusion inhibitors: This is the newest class of anti-HIV drugs. The first drug of this class (enfuvirtide [Fuzeon]) has recently been approved in the United States. Fusion inhibitors block HIV from entering the human immune cell.
• A combination of several drugs called highly active antiretroviral therapy (HAART): This treatment is not a cure. The virus still persists in various body sites such as in the lymph glands.

The antiretroviral drugs do not cure people of the HIV infection or AIDS. They stop viral replication and delay the development of AIDS. However, they may also have side effects that can be severe. These include decrease of red or white blood cells, inflammation of the pancreas, and painful nerve damage. Other complications are enlarged or fatty liver, which may result in liver failure and death.

Recovery and rehabilitation

As there is no cure for AIDS, the focus is on maintaining optimum health, activity, and quality of life rather than on complete recovery.

Occupational therapy can have a crucial role in assisting people living with HIV/AIDS to reengage with life, particularly through vocational rehabilitation programs. Occupational therapy can provide the patient with a series of learning experiences that will enable the individual to make appropriate vocational choices.

Clinical trials

There are many ongoing clinical trials for AIDS. "HIV Vaccine Designed for HIV Infected Adults Taking Anti-HIV Drugs," "When to Start Anti-HIV Drugs in Patients with Opportunistic Infections," and "Outcomes of Anti-HIV Therapy during Early HIV Infection" are some trials that are currently recruiting patients at the National Institute of Allergy and Infectious Diseases (NIAID). Updated information on these and other trials for the study and treatment of AIDS can be found at the National Institutes of Health website for clinical trials at <http://www.clinicaltrials.gov>.

Prognosis

Presently, there is no cure for HIV infection or AIDS, nor is there a vaccine to prevent the HIV infection. However, there are new medications that help slow the progression of the infection and reduce the seriousness of HIV consequences in many people.

Special concerns

The surest way to avoid AIDS is to abstain from sex, or to limit sex to one partner who also limits his or her sex in the same way (monogamy). Condoms are not 100% safe, but if used properly they will greatly reduce the risk of AIDS transmission. Also, avoiding the use of intravenous drugs (drug abuse, sharing contaminated syringes) is highly recommended.

BOOKS

Conner, R. F., L. P. Villarreal, and H. Y. Fan. AIDS: Science and Society. Sudbury, MA: Jones & Bartlett Publishers, 2004.

Stine, G. J. AIDS Update 2004. Essex, England: Pearson Benjamin Cummings, 2003.

PERIODICALS

Grant, A. D, and K. M. De Cock. "ABC of AIDS: HIV Infection and AIDS in the Developing World." BMJ 322 (June 2001): 1475–1478.

OTHER

"AIDS Factsheets." AIDS.ORG. April 20, 2004 (May 27, 2004). <http://www.aids.org/factSheets/>. "

How HIV Causes AIDS." National Institute of Allergy and Infectious Disease. April 20, 2004 (May 27, 2004). <http://www.niaid.nih.gov/factsheets/howhiv.htm>.

UNAIDS. The Joint United Nations Program on HIV/AIDS. April 20, 2004 (May 27, 2004). <http://www.unaids.org/>.

ORGANIZATIONS

Centers for Disease Control (Office of Public Inquiries). Clifton Road, Atlanta, GA 30333. (800) 342-2437. <http://www.cdc.gov>.

National Institute of Allergy and Infectious Disease. 6610 Rockledge Drive MSC 6612, Bethesda, MD 20892-6612. <http://www.niaid.nih.gov/>.

Greiciane Gaburro Paneto

Brenda Wilmoth Lerner, RN

Iuri Drumond Louro, MD, PhD