Although there is no drug or method to cure AIDS, it can be prevented and controlled by antiretroviral treatment, so that patients can live, work and study like normal people, and enjoy the same life expectancy as normal people, it is recommended that infected people go to the local CDC or designated hospitals for active treatment.
I. Why do I need HIV antiretroviral treatment?
HIV antiretroviral treatment can greatly improve the quality of life of patients and prolong their lives; although it cannot be completely cured, it can save lives; it can effectively control the replication of the virus in the body to an undetectable level, which greatly reduces the risk of transmission and reduces the chance of opportunistic infections in patients, enabling them to work and live like normal people.
Second, who needs early HIV antiretroviral treatment?
For patients with poor health condition, CD4+ T-lymphocytes below 350/mm3 and opportunistic infections, treatment should be started as soon as possible after dealing with serious opportunistic infections; for patients with high CD4+ T-lymphocytes, early antiretroviral treatment is also recommended in the absence of opportunistic infections, so that the risk of transmission can be greatly reduced and the quality of life of patients can be improved.
Why should patients in single-positive families receive antiviral therapy as early as possible?
Single-positive families are defined as couples and regular sexual partners in which one partner is infected with HIV and the other partner is not yet infected. Early ART can effectively reduce the replication of HIV in the body and keep the virus in the body at an almost undetectable level, thus greatly reducing the chance of transmission to each other and family members, but this cannot completely avoid the risk of transmission.
Why should all HIV-positive pregnant women be treated with antiviral therapy?
Numerous studies have shown that antiviral treatment can reduce the rate of perinatal HIV transmission (mother-to-child transmission) to less than 2%, which means that the success rate of mother-to-child interruption is as high as 98%. Therefore, it is essential for mothers who are pregnant and want to have a child with HIV.
V. Who should withhold HIV antiretroviral therapy?
Those who have serious heart, liver or kidney diseases should be treated first to make their existing diseases tolerable before ART; those who are in serious opportunistic infections should, in principle, be treated with anti-opportunistic infections for at least 2 weeks before ART; those who have serious neurological or psychiatric diseases; those who are unable to take care of themselves without guardians and those who are unwilling to take medication and have poor compliance.
VI. How to evaluate the efficacy of antiviral treatment?
The effectiveness of treatment is mainly assessed by the following three aspects: virological indicators, immunological indicators and clinical symptoms, with virological changes being the most important indicators.
1. Virological indicators.
For patients treated with HAART regimen, the viral load level in the plasma of most patients should decrease by more than 1 log within 4 weeks, and the viral load can reach undetectable level in 3-6 months after treatment.
2. Immunological indicators.
After 3 months of HAART treatment, a 30% increase in CD4+ T lymphocyte count compared with that before treatment indicates effective treatment, or an increase of 150 CD4+ T lymphocytes/mm3 after the first year of treatment indicates effective treatment.
3. Clinical symptoms.
When the treatment is effective, clinical symptoms can be relieved until they disappear, the incidence of opportunistic infections is greatly reduced, and the mortality rate of AIDS can be greatly reduced or even zero death.
VII. What are the indications and principles of drug change after the virus is not completely suppressed or fails after treatment and serious toxic side effects occur?
(a) Indications for drug change.
1. There are cases where the virus is not completely suppressed or fails after treatment.
(1) After 4 weeks of HAART, the viral load in the plasma has not decreased more than 1 log c/ml from the original level or after 6 months of HAART, the viral load in the plasma has not decreased to the “undetectable” level.
(2) The plasma viral load has reached the “undetectable” level after HAART treatment and then rebounded significantly.
(3) CD4+ T-lymphocyte count does not increase by 25-50/mm3 in the first year after treatment or decreases below the pre-treatment level during the course of treatment.
(4) The patient continues to have recurrent opportunistic infections and/or HIV-associated disease during HAART.
(2) Serious toxicities of ARV drugs occur.
Such as bone marrow suppression, pancreatitis, severe skin rash, fat loss or fat redistribution, hyperlipidemia, severe liver function abnormalities, central nervous system toxicity, etc.
(ii) The principles of drug exchange.
1. Principles of drug change if the virus is not completely suppressed or fails after treatment (adults/adolescents).
(1) Replacement of drugs that appear resistant after analysis based on the results of drug resistance tests.
(2) If resistance tests cannot be performed, all therapeutic drugs should be replaced under possible conditions.
2. Principles and programs of drug replacement due to toxic side effects of drugs (based on our current free first- and second-line drugs).
Therapeutic drugs Major toxic side effects (reasons for changing drugs) Drugs that can be replaced
AZT myelosuppressive effects, severe gastrointestinal reactions TDF
D4T Peripheral neuritis, pancreatitis, lactic acidosis TDF (ABC children)
DDI Fat loss or fat redistribution, lactic acidosis TDF or 3TC
NVP severe liver damage LPV/r
NVP severe rash (non-fatal rash) LPV/r
NVP fatal rash LPV/r
EFV central nervous system toxicity LPV/r
TDF Renal impairment, reduced bone mineral density AZT or referral to a specialist
LPV/r hyperlipidemia, hyperglycemia ATV/r, this drug is not as good as consulting a specialist