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HIV treatment

HIV medication reduces the amount of the virus (your viral load) in your body to very low (undetectable) levels.

HIV treatment doesn't cure HIV. However, if someone with HIV is taking effective treatment and has an undetectable viral load they cannot pass on the virus.

It’s now recommended that everyone diagnosed with HIV starts treatment straight away – regardless of their CD4 count.


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What is an undetectable viral load?

The aim of HIV treatment is to reduce your viral load to undetectable levels. This means that the level of HIV in your blood is so low that it can’t be detected by the tests used to measure viral load.

Different laboratories may have different cut off points when classifying an undetectable viral load, however most clinics in the UK classify undetectable as being below 20 copies/ml.

When you're on effective treatment and have an undetectable viral load, you cannot pass on the virus and HIV is not able to damage your immune system.


What is effective HIV treatment?

We're using the term effective treatment to mean that someone is taking their treatment as prescribed and has an undetectable viral load.

The Partners PrEP study found that there remains a transmission risk for the first six months of treatment, as the HIV positive partner's viral load takes time to come down.

That's why effective treatment means someone has been taking it as prescribed for at least six months and has an undetectable viral load.


Does an undetectable viral load stops me being infectious?

Yes. If you’re taking HIV medication and have an undetectable viral load, you cannot pass on HIV.


How do we know this?

A large study called PARTNER looked at 888 gay and straight couples (and 58,000 sex acts) where one partner was HIV positive and one was HIV negative. Results found that where the HIV positive partner was on treatment and had an undetectable viral load, there were no cases of HIV transmission whether they had anal or vaginal sex without a condom.

The PARTNER study looked at couples where the HIV positive partner had a viral load below 200. Remember that an undetectable viral load is usually classed as being below 20 copies/ml.

Another study called Partner PrEP looked at the risk of transmission in the time it took the HIV positive partner to achieve an undetectable viral load. In most cases (84.8%) this happened within six months and there were no infections once someone had been on treatment for six months or more.


When should I start taking HIV treatment?

In the UK, national guidelines set out standards for HIV treatment. They currently recommend that anyone with HIV who is ready to commit to treatment should start it regardless of their CD4 count.


The START study

The UK guidelines reflect the findings of the START study.

This study found that people who delayed treatment until their CD4 count dropped to 350 - which is when people were previously advised to start treatment - had a significantly higher chance of developing AIDS-related illnesses such as cancers.

Starting treatment will reduce your viral load to undetectable levels and protect your health. Early diagnosis and treatment means people living with HIV can expect to live as long as the general population.

More about the START study ››


How does HIV treatment work?

Treatment with anti-HIV drugs is sometimes called combination therapy because people usually take three different drugs at the same time - often combined into one tablet.

It's also known as antiretroviral therapy (ART), or highly active antiretroviral therapy - HAART for short.

HIV treatment does not cure HIV, but it stops the virus from reproducing in your body. It can reduce the amount of virus in the blood to undetectable levels, meaning that you cannot pass on HIV.


Types of HIV treatment

Over 25 anti-HIV drugs are now available, in six classes of drugs. Each class works against HIV in a particular way. You’ll take a combination of drugs – usually three - sometimes these are combined into one pill known as a ‘fixed dose combination’.

Guidelines recommend several combinations. You and your doctor can choose the one best suited to your health needs and lifestyle. The most important thing you can do is take all your drugs in the right way at the right time (known as ‘adherence’).


What types of anti-HIV drugs are available?

Your HIV healthcare team will have the specialist knowledge to talk to you about what should work best for you. Making sure you take your treatment as recommended is what’s most important.


The classes of anti-HIV drugs are:

  • Nucleoside reverse transcriptase inhibitors (NRTIs or ’nukes’).
  • Nucleotide reverse transcriptase inhibitors (NtRTIs).
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs or ‘non-nukes’).
  • Protease inhibitors (PIs).
  • Fusion and entry inhibitors.
  • Integrase inhibitors.

How do I decide what type of HIV treatment to take?

Guidelines developed by the British HIV Association (BHIVA, the organisation for specialist HIV doctors in the UK) set out the medical treatment people living with HIV in the UK should receive.

These guidelines recommend that everyone with HIV, regardless of their CD4 count, starts treatment, usually with three anti-HIV drugs. This is often called combination therapy. Often two or more of these drugs are combined in one tablet (a fixed dose combination) to reduce the number of pills you need to take.

For people who have not been on HIV treatment, it’s recommended you start on a combination containing two NRTIs and either a ritonavir-boosted protease inhibitor, an NNRTI, or an integrase inhibitor.

The preferred NRTIs for starting HIV treatment are emtricitabine (Emtriva) and tenofovir disproxil (Viread) (also available combined in a pill called Truvada). These drugs are also available combined with efavirenz in a pill called Atripla, combined with rilpivirine in a pill called Eviplera or combined with elvitegravir and cobicistat in a pill called Stribild. Two other NRTIs, lamivudine and abacavir (combined in a pill called Kivexa), are an alternative for some people.

In addition, you'll need to take a third drug.

The guidelines recommend that this is one of the following: atazanavir (Reyataz), darunavir (Prezista), raltegravir (Isentress), dolutegravir (Tivicay), rilpivirine (Edurant) or elvitegravir (Vitekta). Atazanavir and darunavir are boosted with another protease inhibitor, ritonavir (Norvir) to increase their levels in the body. Elvitegravir is boosted by a drug called cobicistat (Tybost) and is usually prescribed in the combination pill called Stribild. An alternative third drug to the preferred options is efavirenz (Sustiva).


What if I'm resistant to the prescribed medication?

If you have taken HIV treatment before, your doctor will need to look at your treatment history and the results of a test for drug resistance, to decide about the most suitable combination of drugs for you to take.

There are now a number of anti-HIV drugs that work against virus that is resistant to other drugs. The recommended options for people who are resistant to the three main classes of drugs - NRTIs, NNRTIs and protease inhibitors - are:

These drugs are most effective when used in combination with another drug which is active against HIV. Your doctor will look at your previous drug history and do a resistance test to find out which would work best for you.

If you're resistant to only one class of drugs, the options may be slightly different and your doctor will advise you.

Thanks to these drugs, an undetectable viral load is now achievable for nearly everyone.

We have published a full list of HIV medication available for UK patients.


What if I have another illness or a co-infection?

You may have a co-infection (such as hepatitis B or C or tuberculosis) or another illness such as cardiovascular disease, HIV-related cancer, chronic kidney disease or HIV associated neurocognitive impairment.

In these situations your doctor may need to tailor your antiretroviral treatment or treat your other condition before starting your HIV treatment. This will be explained to you by the clinicians looking after you.


More on HIV treatment:

Before deciding to stop using condoms, it’s a good idea to speak to your HIV doctor or nurse to make sure your viral load is undetectable.

It’s also important to remember that if you have sex without a condom, other sexually transmitted infections (STIs) can be passed on.

Sex without a condom can also result in an unplanned pregnancy if other contraception is not being used.

If you’re a woman and you’re pregnant, HIV medication is part of the way mother to baby transmission can be prevented.


Next: When to start HIV treatment? ››

 

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The Information Standard: Certified member

This article was last reviewed on 23/1/2017 by Anna Peters

Date due for the next review: 23/1/2020

Content Author: Kerri Virani

Current Owner: Kerri Virani

More information:

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