If you're newly diagnosed with HIV or about to start HIV treatment, you may still be haunted by the old specter of gaunt AIDS patients and few treatment options. HIV/AIDS is still here and it is still a serious disease. But the picture for patients in the U.S. today is very different than it was 30, 15, or even five years ago.
"Life expectancy has improved dramatically," says Babafemi O. Taiwo, MBBS, an internist and assistant professor in the division of infectious diseases at Northwestern University’s Feinberg School of Medicine in Chicago. "For many patients, it can be close to that of uninfected persons."
The treatment that is making this era so much more hopeful is called highly active antiretroviral therapy, or HAART. HAART is a potent combination of at least three active antiretroviral medications (ARVs). HAART is popularly called the “AIDS cocktail" because of its mix of drugs. WebMD talked to HIV/AIDS experts to learn how HAART works and what you can expect from this treatment.
AIDS Cocktails: The Benefits of HAART
The goal of AIDS cocktails today is to reduce the virus in the blood (viral load) so it is no longer detected. Though AIDS cocktails aren’t a cure, they are a very effective treatment. They can delay progression to AIDS, help rebuild and maintain the immune system, and reduce complications.
Today HIV medications are available with fewer short- and long-term side effects.
And taking more than one drug helps prevent drug resistance. This means the drugs will keep working longer because they continue to be effective against HIV.
"Patients who were previously considered untreatable because of multidrug resistance have become treatable," Taiwo says. That's because people have not developed resistance to drugs in the new classes, and the drugs are stronger in overcoming resistance. "It's hard to find patients who truly have no antiviral options, whereas that was common just five to seven years ago," Taiwo tells WebMD.
"With multiple options now available, we don't think there is any excuse for a patient to be failing therapy or to have a detectable viral load if we manage things correctly," says Monica Gandhi, MD, MPH, associate professor of medicine in the divisions of HIV/AIDS and infectious diseases at the University of California in San Francisco and director of the HIV Consult Service at San Francisco General Hospital.
HIV Medications: How HAART Works
Initial treatment against HIV targets three key enzymes -- reverse transcriptase, protease, and integrase. These are all needed for the virus to make copies of itself. Different classes of drugs target different enzymes and prevent them from functioning:
- Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Protease inhibitors (PIs)
- Integrase inhibitors
The FDA has approved several of these medications, which can be taken in various combinations and schedules (regimens). In addition, other HIV medications -- such as fusion or entry inhibitors, which block HIV's entry into a cell -- may be part of treatment.