HIV Welcome to the Affordable Drugs HIV information page. If you, or someone you love, has recently received an HIV diagnosis and are HIV positive it can feel very scary. The first step in removing the fear and feeling hopeful is educating yourself about the disease. With all the HIV research that has been done, medications for treating HIV have come a very long way. People with HIV can now live long, happy and healthy lives. Here you can learn about the HIV virus, HIV transmission, HIV symptoms, HIV testing, etc. You can also find the best available prices on HIV medications. The information contained on this page is not intended to replace the professional advice of your physician.
What is HIV? HIV, which stands for human immunodeficiency virus, is the virus that causes AIDS, or Acquired Immunodeficiency Syndrome. HIV itself is a specific type of virus called a retrovirus, which means that the genetic information encoded in HIV is translated from RNA into DNA inside the human cells that its infects. What this means in practical terms is that the human immunodeficiency virus has a high mutation rate, meaning that the virus can naturally adapt resistance to a wide range of medications. Also, this high mutation rate means that HIV can currently not be eliminated from the human body, the best outcome is just being able to inhibit HIV's growth in a given patient.
What is HIV and how is it spread?
Because HIV is virus, it is very small and contained within all of the bodily fluids of a person who is positive for HIV. Passage of HIV between two people occurs mostly commonly via transmission of bodily fluids. This most commonly occurs through sexual intercourse or if an HIV-positive person's blood is introduced into another person's body (e.g. through blood transfusion or sharing of needles for IV drug use). You can not get HIV by hugging a person or simply touching a person who is positive for HIV.
Scientists predicted that a vaccine that provides immunity against HIV would be produced within a decade after HIV was discovered to be the cause of AIDS. However, this has proven to be very difficult, mostly due to the fact that HIV, the human immunodeficiency virus, actually infects many different types of cells of the human immune system, thus making the immune system less able to mount an attack against HIV. Also, because the HIV virus has a high mutation rate, it can switch between different sub-types of HIV, making a vaccine much less effective. Current trials of vaccines against HIV have been unsuccessful. Many experts highly recommend education of the public to decrease the transmission of HIV, and the use of antiretroviral medications in those infected with HIV.
The class of medications called antiretroviral medications have had success with decreasing how the human immunodeficiency virus reproduces itself in the human body. These antiretroviral medications are specifically tailored to attack certain vulnerabilities of the HIV virus. When consistently taken in combination these medications have been proven to delay the progression from asymptomatic infection with HIV to AIDS, which has many different symptoms and may require hospitalization. If a patient does not take their antiretroviral combination consistently, and misses doses, then this gives HIV the opportunity to mutate into a strain that is not inhibited by the antiretroviral medications the patient is taking. This may lead to treatment failure in a given patient when the strain of HIV circulating in their body no longer responds to antiretroviral medication, and the progression to AIDS will be difficult to slow down.
HIV Symptoms It is most important to make sure that you keep a watchful eye on the symptoms of HIV. There are many different symptoms, which will occur at different phases of infection, which can be detected. It is important to get treatment early if you have been infected by HIV.
HIV bears different symptoms based on the amount of time the infection has matured. In the early stages, right after the virus first enters the body and starts to attack, the symptoms are not unlike that of a very bad flu. Fever, rashes, headaches, swollen lymph nodes, and sore throat may occur. At this phase, the symptoms may be very minor, and you may also not have HIV symptoms at all. Even when you have no symptoms of HIV, it might by possible to spread the virus to others.
Later on, the symptoms of HIV may change and worsen. This would usually occur a great amount of time after the initial exposure, possibly as long as a few years. These symptoms include weight loss, diarrhea, fever, swollen lymph nodes, shortness of breath, and coughing. Over time HIV works to reduce your body's natural resistance to disease, and the HIV symptoms come from that.
The final phase of the infection has the most noticeably extreme symptoms. The goal would be to detect the disease before this point, but sometimes that does not occur. HIV symptoms for the late stages include development of an opportunistic infection, such as pneumocystis carinii pneumonia. If your CD4 lymphocyte count is 200 or less, that would also be considered one of the possible symptoms of HIV. Once AIDS has developed, there will be extreme symptoms which come from opportunistic infections. These symptoms may include chronic diarrhea, night sweats, shaking chills or fever, white spots called thrush on your tongue or inside of your mouth, weight loss, distorted vision, unexplained fatigue, and long term swelling of lymph nodes.
It is important for sexually active people to regularly test for HIV, rather than waiting for symptoms of HIV as a means of determining their level of health. The earlier HIV symptoms can be identified, the earlier treatment can begin. Testing early and often, and treating early, can make a life or death difference when talking about HIV.
HIV Testing With HIV and AIDS becoming an increasing problem in the United States as well as the entire world, more and more people are choosing to get an HIV test. There are various reasons that a person should get an HIV test, and multiple ways the testing can be done.
HIV testing is done so that people who are are at risk of being infected will know their status (i.e. positive or negative), and can protect their sexual partners from contracting the disease as well. Also, someone who knows that he or she is HIV positive can begin treatment for the infection before it develops into full-blown AIDS. Once full-blown AIDS develops, treatments may not be as effective and quality of life may diminish. However, if treatment is started early, a prolonged life with good quality is possible.
Anyone who is part of a "high-risk" group should consider taking an HIV test. These groups include anyone who has ever used intravenous (IV) drugs, particularly if he or she has shared needles with anyone, any male who has had unprotected homosexual intercourse, commercial sex workers, and current or former prisoners who have had sexual contact while incarcerated. Anyone who has had unprotected sex with someone who is in a high-risk group is also at risk of contracting HIV, and should take an HIV test. Anyone who has been diagnosed with another sexually transmitted disease could also have contracted HIV, and should also undergo HIV testing. Pregnant women are encouraged to be tested for HIV, to lessen the risks of transmitting the infection to their unborn children.
HIV testing procedures vary, but blood is most commonly screened for infection. Other body fluids such as saliva or urine may also be used for HIV testing. There are several different types of HIV tests, including rapid and home testing kits. Rapid HIV tests can return a result in as little as 20 minutes. Conventional HIV testing procedures take a few days for results. Home testing kits are available, but currently only one such test, the Home Access HIV-1 Test System, is FDA-approved. Home testing kits, like regular lab HIV testing, take a few days to return results, but you must also add mailing time for home test results.
HIV testing is most accurate after 3 months have passed between exposure and testing. However, most people will test positive within 2-8 weeks of exposure. Any negative HIV test result within 3 months of exposure infection should be repeated after the 3 months have passed, to be certain of the results. Any positive HIV test result, regardless of time since exposure, should be repeated to confirm infection.
Both partners in a relationship should be tested for HIV at the same time, since a negative result for one is not a guarantee that the other is negative. Safe sex precautions such as condoms should be used until both partners are confirmed to be HIV negative. Condom use should be continued even after both partners have obtained negative result if either continues high-risk behavior, or if the relationship isn't monogamous.
HIV Statistics Years ago, an HIV diagnosis was considered a death sentence. Today, thanks to new treatment protocols and a new cadre of highly effective drugs such as anti-retroviral medications, people with HIV and AIDS are living longer than ever dreamed possible. In fact, with high-quality medical care, people with HIV can enjoy an excellent quality of life for decades.
These radical changes in the medical treatment of HIV have led to corresponding shifts in the HIV statistics. The number of people infected with HIV/AIDS globally has risen sharply from approximately 8 million in 1990 to over 30 million in 2008, as estimated by the United Nations. In part, this dramatic rise may be due to slightly increased transmission rates, since new HIV diagnoses have more than tripled over this time period.
Happily, however, the rise in number of people living with HIV/AIDS also reflects increasingly higher disease survival rates. Death rates among people with HIV/AIDS have not increased at an expected rate, hovering around 2 million per year up from under .5 million in 1990, indicating that a smaller percentage of those with AIDS die each year than in the past, especially in the United States and Western Europe. In fact, in the last four years, death rates have actually begun to drop, indicating that new treatments and technologies in the developed world, as well as health care outreach in the developing world have begun to impact HIV statistics significantly.
However, there are still considerable gains yet to attain, since in many countries in the developing world, fewer than 20 percent of people with HIV are taking anti-retroviral medications -- the gold standard in HIV treatment. The proportion of pregnant women with HIV receiving anti-retrovirals - critical in preventing mother-child transmission - are also abysmal, falling under 25 percent in 36 countries and under 50 percent in a further 16 countries. Since mother-child transmission is an important disease vector that leads to greatly increased numbers of new cases and significant infant mortality, these particular HIV statistics are particularly troubling.
Another arena in which gains still need to be made is in the context of outreach to at-risk groups. According to the United Nations, in countries without anti-discrimination laws that might protect members of at-risk groups, HIV/AIDS prevention outreach lags significantly, resulting in increased transmission and mortality. For example, the median percentage of the population of sex workers, injecting drug users, and men who have sex with men reached by HIV prevention strategies in countries with adequate non-discrimination laws and regulations are approximately 75, 70, and 55 percent respectively. In comparison, in countries with inadequate non-discrimination laws and regulations, these numbers are significantly lower at about 60, 25, and 30 percent respectively. According to the United Nations and other advocacy groups, the implication is that HIV statistics can be slashed via political action focusing on discrimination policy and human rights issues. The following statistics are provided by the Center for Disease Control: HIV Prevalence Estimate Prevalence is the number of people living with HIV infection at the end of a given year. At the end of 2006, an estimated 1,106,400 persons (95% confidence interval 1,056,400-1,156,400) in the United States were living with HIV infection, with 21% undiagnosed.1 HIV Incidence Estimate Incidence is the number of new HIV infections that occur during a given year. In 2008, CDC estimated that approximately 56,300 people were newly infected with HIV in 20061 (the most recent year that data are available). Over half (53%) of these new infections occurred in gay and bisexual men. Black/African American men and women were also strongly affected and were estimated to have an incidence rate than was 7 times as high as the incidence rate among whites. 1Hall HI, Ruiguang S, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520-529. AIDS Cases In 2007, the estimated number of persons diagnosed with AIDS in the United States and dependent areas was 37,041. Of these, 35,962 were diagnosed in the 50 states and the District of Columbia and 812 were diagnosed in the dependent areas. In the 50 states and the District of Columbia, adult and adolescent AIDS cases totaled 35,934 with 26,355 cases in males and 9,579 cases in females, and 28 cases estimated in children under age 13 years. The cumulative estimated number of diagnoses of AIDS through 2007 in the United States and dependent areas was 1,051,875. Of these, 1,018,428 were diagnosed in the 50 states and the District of Columbia and 32,051 were diagnosed in the dependent areas. In the 50 states and the District of Columbia, adult and adolescent AIDS cases totaled 1,009,220 with 810,676 cases in males and 198,544 cases in females, and 9,209 cases estimated in children under age 13 years. These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor, but not for incomplete reporting. Totals include persons of unknown race or multiple races, persons of unknown sex, and persons of unknown state of residence. Because totals were calculated independently of the values for the subpopulations, subpopulation values may not equal the totals. Persons Living with AIDS At the end of 2007, the estimated number of persons living with AIDS in the United States and dependent areas was 468,578. In the 50 states and the District of Columbia, this included 454,747 adults and adolescents, and 889 children under age 13 years. Totals include persons of unknown race or multiple races, persons of unknown sex, and persons of unknown state of residence. Because totals were calculated independently of the values for the subpopulations, subpopulation values may not equal the totals. Deaths of Persons with AIDS In 2007, the estimated number of deaths of persons with AIDS in the United States and dependent areas was 14,561. In the 50 states and the District of Columbia, this included 14,105 adults and adolescents, and 5 children under age 13 years. The cumulative estimated number of deaths of persons with AIDS in the United States and dependent areas, through 2007, was 583,298. In the 50 states and the District of Columbia, this included 557,902 adults and adolescents, and 4,891 children under age 13 years. Totals include persons of unknown race or multiple races, persons of unknown sex, and persons of unknown state of residence. Because totals were calculated independently of the values for the subpopulations, subpopulation values may not equal the totals. HIV/AIDS Cases In 2007, the estimated number of cases of HIV/AIDS diagnosed in the 34 states and 5 dependent areas with confidential name-based HIV infection reporting was 44,084. Of these, 42,655 were in the 34 states and 1,429 were in the 5 dependent areas. In the 34 states, adult and adolescent HIV/AIDS cases totaled 42,495 with 31,518 cases in males and 10,977 cases in females, and 159 cases estimated in children under age 13 years. These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor, but not for incomplete reporting.
Totals include persons of unknown race or multiple races, persons of unknown sex, and persons of unknown state of residence. Because totals were calculated independently of the values for the subpopulations, subpopulation values may not equal the totals.
HIV Research Ongoing Studies and Investigations in HIV Research
Great strides have been made in the research and investigative efforts of HIV research teams in search of treatments to fight HIV since the introduction of the disease in the early part of the 1980's. However, there is currently no cure or vaccine for this life-threatening virus. Ongoing investigative HIV research into possible drugs or vaccines to treat or prevent the spread of the virus continues in full force at research institutes worldwide, as hope of one day putting a stop to this deadly infection is greatly anticipated.
While a number of drugs and a variety of treatments for HIV have been approved by the Food and Drug Administration, a great many are still in the investigative stages of development at HIV Research Institutes. Below are just a few of the potential drugs currently being studied for approval by the FDA:
�Entry and Fusion Inhibitors are antiretroviral drugs used in combination therapy that prevent the virus from entering healthy T-cells, thus preventing reproduction of the virus as well as preserving healthy cells in the body. Entry and Fusion Inhibitors currently being studied in HIV research include:
AMD070
A CXCR4 inhibitor also referred to as AMD11070. AMD070 is produced in capsule form. Side effects of this drug found in clinical studies performed on animals include nausea, diarrhea, elevated heart level, fluctuating blood pressure, as well as changes in the thymus and bone marrow. While human studies of the effects of this drug have yet to be conducted extensively, some HIV patients who have been given AMD070 have complained of mild upset stomach or headaches.
TNX-355
An entry inhibitor given intravenously, TNX-355is currently undergoing clinical trials to investigate different dosage levels. While few studies of the effects of this drug on humans have been conducted at this early stage, TNX-355 has produced little, if any, side effects in human studies to date.
�Integrase Inhibitors are antiretroviral drugs that block the enzyme in HIV that integrates itself into the healthy T-cells. By blocking this integration, the virus is prevented from replicating within the body. The following Integrase Inhibitors are under investigative studies in HIV research:
GS 9137 (elvitegravir)
Taken by mouth, GS 9137 is currently being studied for dosage levels, and is given in combination with ritonavir 100 mg. Some side effects include headache and loss of appetite. Liver enzyme levels have reportedly elevated in some patients.
�Microbicides are an HIV research development in preventative compounds that may help reduce the initial infection of the virus. Microbicides not yet approved by the FDA include:
Carrageenan
A chemical commonly found in seaweed, Carrageenan is being investigated and developed into a vaginal gel referred to as Carraguard. In laboratory studies, Carrageenan has been found to protect cells from being invaded by HIV. Some side effects may include pain, itching, or burning in the vaginal area.
�Reverse Transcriptase Inhibitors are antiretroviral drugs that stop the activity of the reverse Transcriptase enzyme needed by HIV in order to reproduce. Reverse Transcriptase Inhibitors currently under study in HIV research include both Non-nucleoside and Nucleoside:
Rilpivirine (TMC278)
A non-nucleoside Reverse Transcriptase Inhibitor that is produced in tablet form and taken once daily with food, Ripivirine is undergoing studies to determine dosage levels. Some reported side effects include fatigue, headache, and nausea.
Fosalvudine
Fosalvudine is a nucleoside Reverse Transcriptase Inhibitor taken by mouth and is currently in clinical studies to determine dosage levels. Reported side effects include headache, nausea, and diarrhea.
�Vaccines
While there are currently no vaccines on the market approved by the FDA for use against HIV, a number of clinical trials are currently being conducted by HIV research teams worldwide in an effort to combat the HIV and AIDS pandemic that has swept the world since the discovery of the deadly virus only 3 decades ago. Efforts are being made towards the discovery and creation of two types of HIV vaccines, a Preventative vaccine to prevent infection of HIV in individuals who test negative for the virus, and a Therapeutic vaccine to boost the immune systems of individuals who test positive for the virus.
RECENT BREAKTHROUGH
According to the most recent breakthroughs in HIV research, scientists have reported the discovery of two powerful antibodies to HIV. In conjunction with Theraclone Sciences located in Seattle, Washington, and Monogram Biosciences located in San Francisco, California, the HIV research efforts of The Scripps Research Institute in La Jolla, California has led to the discovery of what could one day lead to a long sought after vaccine for HIV. The two rare antibodies, called broadly neutralizing antibodies, and referred to as bNabs, are being identified as PG9 and PG16. While the study of these two neutralizing antibodies is still in its very earliest stages, HIV research scientists are hopeful that this recent discovery could lead to the possible creation of a vaccine that will neutralize HIV before it progresses into full blown AIDS.
HIV Treatments What is Antiretroviral Treatment for HIV?
Antiretroviral drugs such as AZT have been used for the treatment of HIV since the late 1980s. In order for these drugs to be effective they are used in combinations of three or more in what is commonly called Highly Active Antiretroviral Therapy or HAART. Common names for antiretroviral drugs are: antiretrovirals, anti-HIV, anti-AIDS, HIV antiviral drugs and ARVs. The drugs suppress HIV by blocking its ability to replicate itself.
The reason for utilizing combinations of antiretroviral treatments is that as HIV infects cells then replicates itself. it does so very quickly, which results in a higher error rate and rapid mutation. Because of this, most of the mutations are deficient in their ability to reproduce, however, the high level of reproduction can result in mutations that are superior to the parent virus. This enables them to get past the body's immune system and become resistant to antiretroviral drugs. By using the drugs in combination there is less of a chance that a virus will become resistant to all of them. Further, combinations of antiretroviral drugs create more barriers to HIV replication, thus slowing down the production of a possibly superior and drug resistant mutation.
When Should Treatment Begin
The World Health Organization has developed a system of detailing the clinical stages of HIV known as the WHO staging system for HIV disease, based on the level of CD4+ T-cells present per cubic millimeter. The guidelines for when to begin antiretroviral HIV treatments in developing nations are based on this system. In countries that are developed, the International AIDS Society-USA has set guidelines for treatment. In August of 2008 the Journal of the American Medical Association recommended that treatment begin before CD4+ cell counts degraded to under 350/uL. Ultimately, the decision of when and whether treatment should begin lies solely with the doctor and their patient.
Types of Antiretroviral Drugs
There are several classes of antiretroviral drugs used in the treatment of HIV. Deciding which classes of HIV drugs to use in the treatment regimen is determined by how the drugs interact with each other, their effectiveness when taken with other drugs and different patient considerations such as allergic reactions and side effects. The current classes of HIV medications include Multi-class Combination Products, Nucleoside Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Protease Inhibitors (PIs), Fusion Inhibitors and Entry Inhibitors (CCR5 co-receptor antagonist), Integrase Inhibitors and Pharmacokinetic Enhancers.
The only Multi-class Combination Product at this time is Atripla. Atripla is a tablet taken once daily. It contains a non-nucleoside reverse transcriptase inhibitor and two nucleoside reverse transcriptase inhibitors. For obvious reasons taking just one tablet is easier than taking three.
Currently available Nucleoside Reverse Transcriptase Inhibitors are Combivir, Emtriva, Epivir, Epzicom, Retrovir, Trizivir, Truvada, Videx, Videx EC, Viread, Zerit and Ziagen. These drugs are comprised of defective versions of the nucleotides used to convert RNA to DNA. When a reverse transcriptase utilizes this defective nucleotide, the resulting DNA cannot be built correctly. Thus HIV's genetic matter is not incorporated into the healthy genetic matter of the infected cell and keeps it from creating new virus.
Non-Nucleoside Reverse Transcriptase Inhibitors include Intelence, Rescriptor, Sustiva and Viramune. "Non-nucleosides" affix themselves to the reverse transcriptase and keep the enzyme from converting RNA to DNA. The effect on HIV is the same as that of Nucleoside Reverse Transcriptase Inhibitors.
Protese Inhibitors block HIV's protease enzyme, which prevents the infected cell from making new virus. The drugs available in this class are Agenerase, Aptivus, Crixivan, Invirase, Kaletra, Lexiva, Norvir, Prezista, Reyataz and Viracept.
The two Entry/Fusion Inhibitors, Fuzeon and Selzentry, attach themselves to proteins located on the CD4 cells or on the HIV's surface. This prevents the HIV's outer wall from binding to the proteins on the CD4 cell's surface. When successful, HIV is unable to bind to the CD4 cell's surface or gain entry into the cell.
The only approved Integrase inhibitor is Isentress. Isentress blocks the process of RNA to DNA conversion and incorporation into the CD4 cell. This, then, prevents the cell from producing new HIV virus.
Side Effects and Limitations of Antiretroviral Drug Therapy
The biggest limitation on the aforementioned HIV treatments is if the HIV infection becomes resistant to the drugs. Because these drugs are only a treatment and not a cure for the disease, HIV resistance to the drugs can close down many options. Once this has happened the prognosis of the patient affected declines.
The side-effects of antiretroviral drug therapies are numerous and can include one or more of the following: Abdominal pain, Diarrhea, Fanconi syndrome, Headache, Ingrown nails, Jaundice, Lipodystrophy, Malaise, Nausea, Oral ulcers, Pancreatitis, Rash, Somnolence, Vomiting, Xeroderma, Alopecia, Dizziness, Flatulence, Hepatitis, Insomnia, Liver failure, Mental confusion, Neutropenia, Paresthesia, Renal failure, Stevens-Johnson syndrome, Xerostomia, Anemia, Hyperbilirubinemia, Migraines, Neutropenia, Peripheral neuropathy, Asthenia, Hypercholesterolemia, Mitochondrial toxicity, Myopathy, Mood swings, Myalgic Encephalomyelitis and Myalgia.
HIV medications and HIV treatments can extend the life expectancy of an HIV positive patient and allow the patient to live longer without ever developing full-blown AIDS. However, the one thing that is of the utmost importance in situations where antiretroviral drug treatments are used is to adhere to the regimen prescribed by the physician. If this regimen is not followed, there is a distinct possibility that the body will not absorb the drugs. This increases the risk of HIV becoming drug resistant. For those who are experiencing AIDS and its effects, antiretroviral treatments can prolong life expectancy to greater than the normal prognosis of one year.
Research continues on new drugs that can be used to fight the HIV and AIDS epidemic and many drugs are awaiting FDA approval at this time. This research, along with new experimental drugs and drug combinations, is providing new hope in the fight against HIV and AIDS for those who have the disease and their loved ones. This hope feeds the fire that helps many physicians and patients continue to fight the daily battle that is associated with this devastating disease.
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