HIV Treatment

Anti-retroviral Medication

Definition: Anti-retroviral medication, or ARV, is the preferred, proven treatment for those with HIV infection. It consists of a combination of drugs that must be taken daily. Anti-retroviral treatment is used to maintain low levels of HIV in the body. When used appropriately, ARVs helps preserve a functional immune system and can significantly slow down the progression of HIV infection to AIDS (1).

What's the Problem?

At the end of 2007, approximately 33.2 million persons were living with HIV infection, with about 67% in Sub-Saharan Africa (2), where it is the number one cause of adult deaths. The majority of those living with HIV/AIDS are women and children. Globally, almost 6,000 women of reproductive age become infected with HIV every day.

HIV is a virus that suppresses the immune system of the infected person. It finds and destroys a type of white blood cell (T cells or CD4 cells) that the immune system must have to fight disease. It is spread from person to person through contact with HIV-infected blood or other infected bodily fluids such as semen.

HIV can remain dormant in the body for 10 or more years without causing outward signs of illness. However, as HIV progresses, symptoms may include enlarged lymph glands, depression, fatigue, fever, yeast infections of the mouth and vagina, night sweats, diarrhea, and loss of appetite, memory, and weight. The HIV-infected person also is more susceptible to illnesses that normally do not affect healthy people. These are called opportunistic illnesses that take advantage of the weakened immune system. An HIV-infected person is considered to have AIDS when their CD4 cell count falls below 200/mL. AIDS is also characterized by the appearance of opportunistic infections. Once HIV is acquired, it is lifelong and leads to death in the majority of cases if untreated.

Most children living with HIV acquire the infection through mother-to-child transmission, which can occur during pregnancy, labor and delivery or during breastfeeding. In the absence of any intervention, the risk of HIV transmission is 15–30% in non-breastfeeding populations (3) (between 30% and 40% of mother-to-child transmission (MTCT) of HIV occurs postnatally through breast-feeding).

Do ARVs Protect Against HIV/AIDS?

ARVs don't protect against HIV infection, but taking ARVs daily, monitoring CD4 count and customizing ARV treatment as necessary can prolong healthy lives of people with HIV postponing, or possibly preventing, the onset of AIDS.

The risk of mother-to-child transmission can be reduced to under 2% by interventions that include ARV medicine given to women during pregnancy and labor, and to the infant in the first weeks of life; obstetrical interventions including elective caesarean delivery (prior to the onset of labor and rupture of membranes); and complete avoidance of breastfeeding.

With these interventions, new HIV infections in children are becoming increasingly rare in many parts of the world, particularly in high-income countries. However, there is a striking variation in coverage among developing countries. In countries like Eastern Europe and Latin America, for example, the prevention services reach at least 50% of all pregnant women living with HIV, while the numbers are significantly lower in most countries in Africa (3). Also due to the lack of safe water supply for many Africans, avoidance of breastfeeding carries risks of waterborne illnesses that can be life-threatening to infants.

The Bottom Line

When used appropriately by HIV positive individuals, ARVs help keep their immune systems functioning properly, protecting them from opportunistic infections and significantly slowing down the progression of HIV infection to AIDS (1). A person living with HIV can therefore lead a relatively normal life with proper ARV medication.

Case Example

Aisha lives in Abidjan, Cote d'Ivoire where she worked as a sex worker at an early age. At age 20, she fell in love with an older man and got married. Six months later, her husband fell very sick and died. She got tested for HIV and found out she was infected. She sought help from a local clinic that offered confidential counseling. The clinic also offered free anti-retroviral medication that she took diligently. Now, three years later, she is in good health, and works as a peer educator to help other women in need (4).