Overview

Human Immunodeficiency Virus (HIV) is a disease that causes the immune system to attack itself. HIV can lead to AIDS (Acquired Immunodeficiency Syndrome) in some patients.

There is no cure for HIV, but it can be managed with medication.

Stages

There are three stages of an HIV infection.

Stage 1: Acute Infection

Acute infection is the earliest stage of HIV and occurs about two to four weeks after being infected.

Some people have symptoms that are similar to flu symptoms. However, some people have no symptoms at all.

During this stage, there is often a high amount of HIV in the bloodstream, therefore the infected patient is very contagious.

Stage 2: Chronic Infection

In the second stage of an HIV infection, the initial symptoms improve and the amount of virus in the blood reduces. The person who is still affected by the virus can still be contagious, however, they do not usually have active symptoms.

If HIV is treated properly, a person may remain in stage two for years or even for the rest of their life without progressing to stage three. They may even progress to the point where there are undetectable levels of HIV in the blood making them much less contagious.

Stage two is sometimes also known as asymptomatic HIV infection.

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

The third stage of HIV infection is when the disease progresses to AIDS. A person with AIDS has a severely impaired immune system.

Left untreated, AIDS is fatal. However, AIDS can be managed with the right medication.

Causes

HIV is contagious through blood and bodily fluids. This virus is a sexually transmitted infection (STI) and is primarily spread through sexual interaction. However, it can also be spread through contact with infected blood, by sharing needles, or by an infected mother to her child during pregnancy, childbirth, or breastfeeding.

Symptoms

During the initial infection, an HIV patient may present with flu-like symptoms. This includes:

• Fever
• Chills
• Rash
• Night Sweats
• Swollen Lymph Nodes
• Muscle Aches/Headaches
• Joint Pain
• Fatigue
• Sore Throat/Mouth Ulcers
• Cough
• Diarrhea
• Weight Loss

However, some people have very mild symptoms or no symptoms at all. It’s important to see a doctor if you believe you may have been exposed to HIV or AIDS.

Treatments

Treatment for HIV involves Antiretroviral Therapy (ART), which reduces the amount of virus in the bloodstream. Medication can be taken in the form of pills or shots.

Antiretroviral therapy works by preventing the virus from multiplying, thus allowing the immune system to function normally and stay healthy.

The patient needs to seek treatment right away and continue taking their medication throughout their lifetime. HIV cannot be cured, but the right treatment will keep the disease from progressing.

With the right treatment, the level of virus in an HIV patient’s bloodstream can become undetectable. Those with undetectable levels of HIV in the blood are not as contagious.

Medications

Antiretroviral therapy medication falls into seven different drug classes. The division is based on how the drugs fight the virus cycle.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

NRTI drugs are typically prescribed early on in treatment as they work the most aggressively at stopping HIV from multiplying. The types of medication that may be prescribed in this category include:

• Ziagen (abacavir)
• Emtriva (emtricitabine)
• Epivir (lamivudine)
• Viread (tenofovir disoproxil fumarate)
• Retrovir (zidovudine)

Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

NRTI drugs can be combined with other types of medicines, including those in the NNRTI category. Some of the types of medications in this category are:

• Pifeltro (doravirine)
• Sustiva (efavirenz)
• Intelence (etravirine)
• Viramune, Viramune XR (nevirapine)
• Edurant (rilpivirine)

Protease Inhibitors (PIs)

Protease Inhibitors (PI) are another type of drug prescribed to HIV patients. Some protease inhibitors doctors prescribe in the US are:

• Reyataz (atazanavir)
• Prezista (darunavir)
• Lexiva (fosamprenavir)
• Lopinavir (available in the combination drug Kaletra)
• Norvir (ritonavir)
• Aptivus (tipranavir)

Fusion Inhibitors

The FDA has approved one fusion inhibitor drug available in the U.S. and that is:

• Enfuvirtide

This drug is usually only prescribed if the patient has a negative reaction to other more well-tested drugs.

CCR5 Antagonists

There is one CCR5 Antagonist drug available in the U.S. and it is known as:

• Maraviroc

Post-Attachment Inhibitors

There is one FDA approved Post-attachment inhibitor on the market and that is:

• Rukobia (fostemsavir)

Integrase Strand Transfer Inhibitors (INSTIs)

In the Integrase inhibitor category, medications include:

• Isentress (raltegravir)
• Tivicay (dolutegravir)
• Vitekta (elvitegravir)
• Triumeq (dolutegravir + abacavir + lamivudine)
• Stribild (elvitegravir + cobicistat + tenofovir + emtricitabine)
• Genvoya (elvitegravir + cobicistat + tenofovir AF + emtricitabine)
• Juluca (dolutegravir + rilpivirine)
• Biktarvy (bictegravir + tenofovir AF + emtricitabine)

These drugs are known to have fewer side effects than NRTI or NNRTI drugs.

Side Effects

Some drugs prescribed to HIV patients can have serious or fatal side effects. HIV patients need to let their doctor know if they experience any ill effects from their prescribed medication.

HIV treatment is multi-faceted that usually involves a combination of different drugs, and the protocol may change over time.