- The HIV virus begins to inflict its damage at the genetic level. The virus enters cells related to the immune system and begins making copies of a portion of the genetic material. It then inserts its own genetic material into the host cells and begins making copies of itself. As this process repeats itself, it gradually weakens the immune system of its host.
- Antiretroviral medications are grouped into subclasses. Each subclass attacks HIV in a different way. Common subclasses are nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors (FIs), CCR5 antagonists and integrase inhibitors. Three recently approved drugs have been included as treatment options: maraviroc, a CC chemokine receptor 5 (CCR5) antagonist; raltegravir, an integrase strand transfer inhibitor; and etravirine, a second-generation NNRTI.
- HIV antiretroviral therapy typically requires that a patient take many medications throughout the day. Side effects are to be expected. Severity of side effects depends on the stage of the illness, other morbid illnesses the HIV-positive person may suffer from and individual tolerances to the drugs in question. It is not unusual for an HIV patient beginning or changing antiretroviral therapy to initially experience nausea, fatigue and generalized weakness or sensation of feeling ill. With time, these side effects may subside. However, physicians must also monitor for more severe effects and signs of rejection of the therapy. Such signs and conditions include kidney problems, insulin resistance and/or treatment-induced diabetes, liver failure, weakening of bones and nervous system effects.
- There is no one-size-fits-all antiretroviral therapy for HIV treatment. Of course, lab studies and treatment goals must be considered before instituting a treatment. Also, the treatment for a newly diagnosed HIV patient in the early stages may differ from the treatment of a newly diagnosed HIV patient in the late stages. There are also those patients considered to be special populations: pregnant women, children and adolescents, illicit drug users and those with other infections. The overall health and lifestyle of the individual must be considered as well. Oftentimes, doctors must consider the likelihood of compliance with treatment from certain patients. Accordingly, doctors must choose the treatment option such patients would be most likely to follow.
- Patients undergoing HIV antiretroviral therapy must understand that treatment does not cure or prevent the spread of HIV. The same precautions and considerations must be followed once treatment begins. There is no cure for HIV, only treatment to lessen the severity of the illness and to slow its progression.
- HIV antiretroviral therapy can be costly given the type of medications used and the number of drugs used in the treatment. Treatment can be as much as several thousand dollars per month. This cost can be difficult for most HIV patients and often affects a patient's initiation and adherence to treatment. However, there are programs available to provide financial assistance to help patients afford HIV antiretroviral therapy.
