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HIV and AIDS Treatment

Treatment

There is neither a cure for AIDS, nor a vaccine for HIV. The primary goal of treatment is to strengthen the immune system and reduce the viral load for as long as possible by inhibiting viral replication. This is done with powerful combination antiretroviral therapy, the mainstay of AIDS treatment. When strictly adhered to, antiretroviral therapy helps to maintain the balance of power between HIV and the immune system, helping to prevent disease.

Another important goal of therapy is to treat AIDS-related cancers and opportunistic infections that develop. Generally, if a patient develops a severe opportunistic infection, treatment for the infection takes priority over antiretroviral therapy, especially if the antibiotic interacts with the antiretroviral medication.

It is also important to help patients maintain the best possible quality of life. This may involve pain management, counseling, and providing assistance to help patients comply with rigid and demanding medication schedules.

Opportunistic Infections and AIDS-Related Cancers
There are two general types of treatment for opportunistic infections and AIDS-related cancers, and both work best in combination with antiretroviral therapy. Treatment may include the following:

  • Antibiotics for HIV-related infections
  • Chemotherapy for HIV-associated cancers
Prevention
With regards to HIV/AIDS, preventative treatment (called prophylaxis) refers to treatment used to prevent AIDS-related infections and illnesses. Primary prophylaxis involves using drugs to prevent infection and secondary prophylaxis (also called maintenance therapy) is used to prevent the recurrence of an infection. For example, according to the World Health Organization (WHO), more than 5 million people are co-infected with HIV and Mycobacterium tuberculosis, the bacteria that causes TB. Prophylaxis can help prevent tuberculosis in patients with HIV.

Prophylactic drugs usually are prescribed according to the patient's CD4+ cell count. A person with a count greater than 500 CD4+ cells per mm usually is not at risk for developing opportunistic infections.

  • When the CD4+ count falls below 500, there is an increased risk for herpes zoster (shingles), oral candidiasis (thrush), tuberculosis, Kaposi's sarcoma, and lymphoma.

  • When the CD4+ count falls below 200, there is an increased risk for the conditions listed above as well as Pneumocystis carinii pneumonia (PCP), toxoplasmosis, cryptococcosis, and severe herpes and candidiasis infection.

  • When the CD4+ count falls below 50-100, there is an increased risk for the above conditions, Mycobacterium avium complex (MAC), and cytomegalovirus (CMV) disease.
The goal of prophylaxis is most often the prevention of PCP in patients with CD4+ counts below 200. It is important to take prophylactic drugs as prescribed. The viruses and bacteria that cause opportunistic infections can develop resistance to prophylactic drugs.

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