HIV Treatment, Prognosis, and Prevention

• HIV disease is not curable, because the virus infects a person's cells throughout the body. HIV prefers to target immune defense cells, and it is this progressive destruction of immune cells that leads to HIV disease and death.
• Although the virus cannot be cured, it can be controlled with anti-retroviral (anti-HIV) medications. These medications halt the production of HIV virus in the infected person's cells, so that numbers of normal cells can recover and resume normal functions again.
• Typically, the treatment regimen involves two to four drugs used together. Treatment is started as soon as HIV infection is diagnosed. Early control of HIV means the drugs will be effective for longer, and the body will suffer less chronic inflammation from uncontrolled infection. We now know, as people with HIV live longer, that chronic inflammation leads to heart disease, diabetes, and other chronic diseases much faster than they occur in people without HIV. The sooner inflammation is stopped, the longer a person with HIV can live.
• Development of anti-retroviral treatment has advanced steadily since the late 1990s, when potent drugs became available. Combination pills with lower side effects have transformed HIV infection into a chronically manageable disease for most people.

The only sure way to prevent HIV/AIDS is not to have sex and not to share IV drugs or equipment with anyone. If you have sex, know your HIV antibody test result and your partner's (both confirmed negative HIV tests), and have sex only in a monogamous relationship with that person. Avoid sex with partners whose HIV results you don't know or who may be taking part in risky behaviors. Use barrier precautions, like condoms or latex barriers, during all genital, oral, and anal sexual contact, especially if you are not sure of your partner's HIV status (note that barrier precautions are very good but not 100% effective in preventing HIV infections).

Do not share IV drugs or injecting equipment with anyone. This is not easy to do, and it is best to seek help from drug treatment professionals. Some areas may have needle exchange programs that allow people to get sterile injecting equipment.

Avoid blood or blood product transfusions in areas of the world where the blood supply may not be strictly screened for HIV. People who are at risk for HIV/AIDS should not donate blood or sperm.

Women who plan to get pregnant should get tested for HIV before and as soon as they become pregnant so that preventive care is started if needed. HIV-infected mothers should not breastfeed because of the risk of the baby being exposed to blood in breast milk.

Very early treatment ("post-exposure" treatment within a few hours) with anti-retroviral medications may be able to prevent HIV transmission in health-care workers exposed to HIV or in people who are exposed sexually. There is pre-exposure treatment (called "pre-exposure prophylaxis" or "PrEP") that may be prescribed for some people at high risk of sexual transmission. This type of preventive treatment is not appropriate for everyone and may cause other problems. It should be discussed with a health-care provider.

• Transmission to others, usually by sex without a condom or sharing IV drugs or injection equipment
• Transmission from mother to baby at birth or during breastfeeding, if the mother is not being treated with anti-retroviral medications at the time
• There can be progressive immune failure if not treated or if the HIV is resistant to medications. Increasing infections progress to unusual types of infections that usually only occur when the immune system is failing ("opportunistic infections").
• If medications are not taken regularly and as prescribed, the HIV becomes resistant quickly and stops responding to treatment. Progressive immune failure will occur just as if the HIV is untreated. If HIV medication must be stopped or missed for any reason, such as for surgery or an illness, it is best to stop all of the medications together and restart them together. Missing even one dose of anti-retroviral medication a week begins to cause resistance.

Untreated HIV disease will progress to increasingly life-threatening infections and wasting syndrome as the virus damages the immune system until death occurs. However, under treatment protocols and with careful attention to taking all doses of medication as prescribed, most people with HIV will live fairly normal lives, although special precautions are still necessary to keep from transmitting HIV to others or from mother to baby.

HIV/AIDS has been and continues to be the subject of intense research ever since the disease was first recognized in the early 1980s. Many researchers continue to look for new and better medications to treat HIV disease. HIV is able to bypass and attack the immune system in complex ways. This has made it very difficult to develop an effective vaccine against HIV, but many researchers have not given up hope and continue to investigate how to do this.

An excellent place to find more facts about HIV/AIDS is with the Centers for Disease Control web site: http://www.cdc.gov/hiv/basics/index.html.