Dr. MJ Bazos MD,
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
- 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.
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
- Zidovudine (also known as AZT and ZDV)--brand
- Didanosine (also known as ddI)--brand name: Videx
- Zalcitabine (also known as ddC)--brand name:
- Lamivudine (also known as 3TC)--brand name:
- 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:
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
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
- 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
What else can
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
- 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
- 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,
- 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.