Treatment

Contrary to popular belief, HIV infection treatment exists since 90s. In fact, with the pharmacological developments following the initial treatments, today’s treatments prescribe one pill per day, whereas it was 25-30 pills per day before. What’s actually confusing in this regard is the meaning attributed to the word “treatment”. There’s a popular belief that “treatment” means destroying the disease factors. Treatment can mean destroying all disease factors, whereas it can also mean the methods that can make the disease “manageable”.

HIV infection is a chronic infection that can be manageable, but cannot be entirely removed from the body. The antiretroviral (effective against retroviruses) inhibitor (stopper, retarder, preventive) medications used in the treatment prevent the harm to immune system and help people maintain a healthy life by preventing HIV’s self-reproduction in human body.

When HIV enters human body, it first clings to CD4 cells, which are immune system cells and the building blocks of defense system. The virus synthesizes DNA from its RNA by leaving its genetical materials in the cell, and articulates into its DNA, making the cell a host operating for it.

The virus produces its proteins in the cell by self-reproduction and destroys the cell, and mixes back with the blood to infect new CD4 cells. This is what HIV does directly from the first moment of infection until the last stage of infection.

Antiretroviral treatment stops the virus’ self-reproduction in human body by using a combination of all medicine groups that stops all these steps one by one. It’s known that viruses are not living organisms and are destroyed when they can’t replicate themselves. The virus load observed in 1mm3 of blood via PCR in the beginning of the treatment decreases to an undetectable level within 6 months since the virus reproduction is halted. And that’s the first goal of HIV treatment.

Second goal of the treatment is to maintain the sustainability of undetectable viral load. Because that’s how the medications not affecting the immune system help; CD4 cells remain at ideal level and maintain their protectiveness.

Why Treatment Continues Although Viral Load is Undetectable?

The fact that viral load decreases to undetectable levels 6 months after the treatment started doesn’t mean that virus is entirely removed from the body. Discontinuation or interruption of treatment, breaking the discipline of medication use result in increase of detected number of virus and a more complicated treatment process.

Although HIV circulates in the blood, it also settles in almost all body fluids,  even in parts antiretroviral medications can’t reach, by passing through blood brain barrier.

Viruses actively circulating in the blood leave sleeper cells called latent in various body parts, which never become active if treatment is taken. When suppressive medications are not taken, these sleeper cells start to produce virus again by becoming active. Therefore, PCR test results show the countable virus loads again.

I Can Restart The Treatment and Suppress The Viral Load Again

You might get the wrong idea that by starting to use the same medication again, you can manage the increased viral load due to breaking the treatment discipline. However at this stage, things won’t proceed as you foresee. When viral load reaches detectable levels again due to breaking the treatment discipline, the virus mutates and might develop resistance against current medications. Resistance development means that the virus knows these medications now and resists against their suppressive effect, meaning that they won’t succeed even if you use them. At this stage, more complicated treatment combinations requiring more pills might be needed and dealing with possible medication side effects might be an issue .

HIV treatment with right combinations is completely successful. However, the key factor directly affecting the success of medications and treatment is the treatment devotion of people living with HIV. Their treatments will be faithful to them as long as they are faithful to their treatments.

Treatment devotion means taking the medication at the same time on a regular basis in doses as prescribed by doctor. While medication intake time is designated by people living with HIV based on their own life conditions, it’s vital to take the medication at the same time every day. In one-pill diets for instance, active substances remain at optimum level in the blood for 24 hours.

It’s aimed to stabilize the ratio of active substances in the blood that enable suppression by taking them every 24 hours without any decrease.

In fact, people living with HIV don’t have to do much to ensure a treatment devotion. For instance, setting an alarm on their cell phones for medication time is one of the most important precautions that stops skipping medication time. And it completely rules out the stress of “Is it my medication time yet?” You’d know that it’s medication time when alarm beeps. On a side note, since it’s not possible to be at the same place at the same time in social life, taking a few pills with you would ensure your regular medication intake. But we never recommend carrying a month’s pillbox in your bag or with you. Instead, we recommend you carry a weekly pillbox or certain number of pills in a box that can protect the pills from direct sunlight and moisture. In case of losing or getting your one month’s medication stolen, it wouldn’t be possible to renew your medication due to its high price. And the health care system won’t give you new pills for the lost ones since you’d seem to have pills on their system (in case of lost medication, please contact our association).