What is the management?

Although the cure for HIV infection is not yet available, the treatment can keep the virus under control and allow the immune system to restore its function.
People on HIV treatment can live a healthy and productive life. If HIV is diagnosed late, there is a higher risk of developing complications, and treatment outcome may be poorer.

The treatment available to an HIV-infected individual serves two main purposes:

1. The use of antiretroviral therapy (ART) to stop the virus from reproducing. This allows the immune system to strengthen and fight infections effectively.
2. Prophylaxis and treatment for opportunistic infections as a result of immunodeficiency.

With the introduction of HAART (Highly Active AntiRetroviral Therapy), people infected with HIV may now lead a near-normal lifespan with good quality of life. HAART, also called the cocktail therapy or the combination therapy, is the standard HIV treatment at present. It is a combination of 3 or more antiretroviral drugs selected from 2 or more classes of drugs. With combined pills, taking the daily medications has become a lot more convenient than before.

There are 5 main classes of drugs:

• Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
• Protease Inhibitors (PIs)
• Entry Inhibitors
• Integrase Inhibitors (INSTIs)

With an effective ART:

• Most HIV-positive guys can achieve an undetectable viral load by maintaining a good adherence. It will in turn allow for a recovery of the CD4 count and allows the immune system to stay strong.
• There is now clear evidence that the sooner you start to take HIV treatment, the sooner you can benefit from it.
• There is fewer chance of acquiring opportunistic infections and HIV-associated cancers.
• The risk of serious health problems that occur more frequently in HIV-positive people could be trimmed down, such as cardiovascular disease, kidney disease, liver disease, neurological complications and various non-AIDS-related cancers and infections.
• Evidence has shown that people with HIV who achieve sustained viral suppression to an undetectable level by antiretroviral drugs have no chance of passing on the virus through sex. (Remember ! It's important to continue to take your HIV medications every day in the way your doctor has instructed and get your viral load monitored.)

• ART should be initiated in all adults and adolescents living with HIV, regardless of clinical stage and at any CD4 cell count, to reduce the morbidity and mortality associated with HIV infection.
• On a case-by-case basis, ART may be deferred because of clinical and/or psychosocial factors, but therapy should be initiated as soon as possible.

Drug adherence is very important to maintain an undetectable viral load and to prevent the emergence of drug resistance. Drug resistance means the reduction of a drug's ability to work against HIV. Suboptimal drug adherence may lead to development of drug resistance rendering your treatment ineffective and will reduce the number of treatment options in the future.

Some tips on successful drug taking are to:

• Know of the right dosage, frequency and ways of taking each drug;
• Try to fit your drug regime with some of your daily routines;
• Set an alarm to remind you the time to take the drugs;
• Put some of your drugs in the places you usually go;
• Bring a bottle of water with you for taking drugs;
• Use a pill box.

HIV RNA (viral load) and CD4 count
Viral load (VL) measures how active HIV is replicating inside our body. The higher the viral load, the higher the risk of transmitting the virus. Effective ART can suppress the virus from replicating. Once the virus is suppressed, our CD4 count will improve, and so as our level of immunity.

CD4 count is a measure of our immune function. If HIV infection is left untreated, it will keep attacking our CD4 cells and weaken our immunity. The CD4 count of an non-infected person may range from 400 to 1,200 cells/mm³. Certain opportunistic infections will start to manifest as our CD4 count drops to below 200 cells/mm³.

Viral load and CD4 count should be measured in all patients at entry into care and regularly thereafter initiation of ART. The baseline CD4 count informs the urgency to initiate ART and helps determine the need to offer prophylaxis for opportunistic infections. The goal of ART is to maintain an undetectable viral load in order to restore the immune function. Viral load monitoring is important to help your doctor decide the effectiveness of therapy. Evidence has shown that as long as you continue to have your viral load monitored to confirm that the level of HIV is suppressed to undetectable levels for at least six months, the chance of passing on the virus would be negligible through sex. At this stage, it is still of vital importance to practice safe sex as HIV can exist in semen and rectal fluids even with an undetectable VL in the blood.

Other Monitoring Tests
Resistance Test - A resistance test will tell if the virus inside a person's body has already become resistant to any HIV medications. It's often best to get resistance tests before you begin any HIV treatment or when there is treatment failure. The best way to avoid drug resistance is to take all your HIV medications on time and consistently.

Looking for STIs and other illnesses - It is recommended to check regularly other sexually transmitted infections (STIs) such as syphilis, hepatitis B and C. If you are already on an antiretroviral treatment, your doctor will monitor your blood sugar, cholesterol, liver and kidney functions etc.