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Dr. MJ Bazos MD, Patient Handout

HIV: Medicines for People Who Are HIV Positive

How can my doctor tell if I have HIV or AIDS?

First your doctor tests to see if you have HIV infection. Your blood is tested with an ELISA (enzyme-linked immunosorbent assay) test. If this test is positive for HIV, your blood is tested again with the Western blot test. If both tests are positive, the diagnosis of HIV infection is confirmed.

Three things show if a person with HIV infection has gotten AIDS. If any one or more of the following are present, the person has AIDS:

A CD4 lymphocyte cell count (discussed below) of less than 200
A CD4 lymphocyte cell percentage of less than 14%
An AIDS-indicator illness

An AIDS-indicator illness is a physician-diagnosed medical problem that occurs in people with advanced HIV infection. About 25 medical problems are considered AIDS-indicator illnesses. They include conditions like Pneumocystis pneumonia, Kaposi's sarcoma and wasting syndrome. If a person with HIV infection gets an AIDS-indicator illness, we say that person has AIDS.

What medicines are used for HIV infection?

Three kinds of medicines are used to fight HIV infection. The first kind is called nucleoside analog reverse transcriptase (say "trans-krip-tase") inhibitors. They act by getting into the genetic information, called the DNA, of the virus. Here they block its building process. Now the virus DNA is not complete. It can't make new virus. These medicines include the following:

Zidovudine (also known as AZT and ZDV)--brand name: Retrovir
Didanosine (also known as ddI)--brand name: Videx
Zalcitabine (also known as ddC)--brand name: Hivid
Lamivudine (also known as 3TC)--brand name: Epivir
Stavudine (also known as d4T)--brand name: Zerit
Abacavir (also known as ABC)--brand name: Ziagen

The second kind of medicine is called a non-nucleoside reverse transcriptase inhibitor. This medicine gets on a part of the virus called the reverse transcriptase enzyme. Here it blocks the making of DNA. This step also means more virus can't get made. This group includes the following medicines:

Delavirdine--brand name: Rescriptor
Nevirapine--brand name: Viramune
Efavirenz (also known as EFV)--brand name: Sustiva

The third kind of medicine is called protease (say "pro-tee-ase") inhibitors. These medicines work by blocking the making and release of HIV from infected cells. This group includes the following medicines:

Saquinavir--brand name: Invirase
Indinavir--brand name: Crixivan
Nelfinavir--brand name: Viracept
Ritonavir--brand name: Norvir
Amprenavir--brand name: Agenerase

The different kinds of medicines are often used together (in combination) to reduce the amount of HIV in the body.

When a protease inhibitor is combined with reverse transcriptase inhibitors, the resulting drug regimen is called a "cocktail." Your doctor must watch you closely when you are taking any of these medicines, to see how well they lower the amount of virus in your body. Your doctor also wants to make sure you aren't having side effects like nausea, vomiting, fatigue, anemia, or peripheral neuropathy (a numb feeling in your hands or feet).

How does the doctor tell if the medicines are working?

Three tests can measure the amount of the virus in your blood. Your doctor can use this information to find out how your body is responding to the medicine.

The CD4 cell count. CD4 cells are a kind of white blood cell (sometimes called T-lymphocytes, or T cells) in your blood. In people who don't have HIV, the CD4 level is between 800 and 1,200 cells per mm³ (cubic millimeter). CD4 cells are important because they help your body fight infections. Unfortunately, these cells are also the main target of the virus that causes HIV infection. This virus cripples the CD4 cells. Your doctor will probably give you medicine to fight HIV when your CD4 cell count drops below a certain level. One goal of treatment for HIV infection is to keep your CD4 cell count as high as possible.
Viral load. The viral load is the number of copies of the HIV virus in your blood. A person who doesn't have HIV infection has a viral load of 0. Medicine that lowers the amount of HIV in the body is usually given when your viral load measures more than 10,000 to 30,000 viral copies per mL (milliliter) of blood. A second goal of treatment is to make the viral load as low as possible.
CBC. The complete blood count (also called the CBC) measures the number of red and white cells in your blood. Red blood cells carry oxygen from your lungs to all the tissues of your body. White blood cells fight infections. They keep your body's immune system strong. A large drop in red blood cells and a large drop in white blood cells can occur when HIV infection is getting worse. This drop can also be caused by the same medicines that you take to fight HIV (medicines like zidovudine). Your doctor checks your CBC count to help decide when to change your medicines. Your doctor wants to keep your red and white blood cell counts high enough to keep you healthy.

What happens during a routine office visit?

Your doctor will check several things to find out how strong your HIV infection has become. Your doctor will ask you about your symptoms. He or she will look for any signs that the HIV infection is getting worse. Your doctor will also do a blood test to check your CD4 cell count and your viral load. Some of the things that might tell your doctor that your HIV infection has not gotten worse since your last visit are the following:

No new symptoms of nausea, vomiting, fatigue, fever, headache, chills, night sweats, cough, shortness of breath or diarrhea.
No signs of weight loss, mouth sores (such as thrush, which is a yeast infection) or bigger lymph glands (lymph glands are in your neck, armpits and hip area).
No drop in the CD4 cell count in your blood.
No rise in the viral load in your blood.

How often will my doctor want to see me?

Your doctor will probably want to see you every 6 months as long as your CD4 cell count is higher than 500. Your doctor will probably want to see you every 3 months if your CD4 cell counts are below 500. However, if you take a new medicine, your doctor will want to see you more often, to check your response to the medicine or to see if your HIV disease is getting worse.

What else can help me?

Some medicines can help you not get the other infections and complications that come when HIV lowers your body's resistance (makes your immune system weak). Here are some things that can help people with HIV:

An influenza ("flu") shot every fall helps prevent the flu.
A shot every 5 to 7 years can prevent pneumonia caused by the bacteria called Streptococcus pneumoniae. It's easier for people with HIV to get this kind of pneumonia.
A tuberculosis (TB) skin test every year can tell if you have TB. TB is a very serious illness, especially in people with HIV.
A Pap test for women to check for dysplasia (a pre-cancer condition) and for cancer of the cervix. Both of these conditions happen more often in women who have HIV infection. At first, Pap tests are done every 6 months. After 2 Pap tests in a row are normal, you might only have to get them once a year.
A hepatitis B test for people who are at risk for hepatitis B infection. You're at risk for this infection if you inject drugs. If the test shows you don't have hepatitis B infection, your doctor might want you to have the hepatitis B vaccine. It would protect you from getting hepatitis B infection.
A medicine called TMP-SMZ (brand names: Bactrim, Septra) can help. This antibiotic would be given to you if your CD4 cell count is less than 200. It helps you not get pneumonia caused by a bacteria called Pneumocystis carinii. This antibiotic also helps you not get another infection, called toxoplasmosis.
Azithromycin (brand name: Zithromax), clarithromycin (brand name: Biaxin) and rifabutin (brand name: Mycobutin) can help when your CD4 cell count is lower than 50 to 75. They keep you from getting an infection caused by a bacteria called Mycobacterium avium.