Exploring your options: Treating HIV/AIDS

How is HIV treated?

Everyone living with HIV should receive treatment to keep the amount of the HIV virus in their body (known as “viral load”) as low as possible. Treatment usually includes a combination of several anti-HIV or “antiretroviral” drugs often referred to as ARVs. These drugs prevent the virus from reproducing itself inside your body. If you take your anti-HIV medicines as prescribed, it lowers your risk of becoming sick or passing on HIV.

What happens if I forget to take my medication?

It’s extremely important to take your medication exactly as prescribed by your doctor. If you forget to take your medication, take it as soon as you remember, then continue according to your usual schedule. Ask your pharmacist about compliance blister packs, a medication packaging system that can reduce the risk of forgetting your pills.

If you don’t take anti-HIV medicine properly, your HIV infection may become resistant to the drugs, and the amount of the virus in your body (the viral load) will begin to rise again. This could cause potential damage to your vital organs—such as kidneys, heart or brain—by the process of inflammation. If your viral load becomes detectable, you also risk passing your HIV infection along to any sexual partners.

What about other medications I take—will the anti-HIV drugs affect them?

Speak with your doctor or pharmacist about every medication you’re taking—even over-the-counter pills and health products.

Once you start taking anti-HIV medication, be sure to speak with your doctor or your pharmacist before starting any new medications, prescription or otherwise.

If you use illicit drugs, some may interact with your anti-HIV medication. Talk to your doctor or pharmacist about them.

Are generic anti-HIV drugs just as effective as the brand-name ones?

Yes. Generic drugs in Canada are tested to ensure they deliver the same active ingredient, in the same dose and for the same length of time as their brand-name equivalents.

What’s on the horizon in terms of treatments or a cure?

Currently, several new anti-HIV drugs are being studied and developed. Some are:

• pills that have a better tolerability and drug-drug interaction profile than their relatives of the same class
• new classes of medication using novel routes to halt virus reproduction or to prevent the cells from being infected
• new ways of administering the drugs, such as implants or injections that can be performed weekly, monthly or even every two months

Unfortunately, we are still far from finding the real cure for HIV. The virus is very tricky and likes to hide in different cells and tissues of the body. We refer to the hidden virus as the “reservoir.” Even if a patient is treated and has an undetectable viral load, once he or she stops the anti-HIV treatment, the hidden virus sneaks out of the reservoir and restarts its devastation. Several approaches are currently being studied, including the use of cells infected by different genetically modified viruses like the cytomegalovirus (CMV), which then attack the cells infected with HIV and eliminate them.

As of today, one patient, known as the Berlin Patient, achieved a “functional cure” for HIV after undergoing heavy chemotherapy treatment with bone marrow transplant for his leukemia. This patient has been with no viral replication since his treatment in 2007.

Why do we call him functionally cured, rather than simply “cured”? We cannot call him cured, because he still has cells containing the HIV virus; however, his transplanted new cells (stem cells) do not contain the type of receptor, called CCR5, necessary for his type of virus. His cells contain only the CXCR4 receptor.

Essentially, imagine a very round, short person; a very tall, slim person; and a very tall, narrow door. The round person won’t be able to enter the room. This is what happened with the patient’s virus: the patient’s new cells have a “door” (receptor) that does not suit the shape of his existing virus, thus he has no viral reproduction and has achieved a functional cure.