Therapy for HIV Infection

Therapy for HIV infection is a multifaceted approach that includes various treatment options aimed at different stages of the disease. The primary goal is to control the virus, prevent or treat opportunistic infections, and improve the quality of life of the patients.

Antiretroviral Therapy (ART)

Antiretroviral therapy (ART) is a cornerstone in HIV treatment. It involves the use of drugs that inhibit the virus's ability to replicate, thus slowing down the progression of the disease. The selection of these drugs is based on their ability to effectively suppress viral replication with minimal toxicity, penetrate target cells, and cross the blood-brain barrier.

The Mechanism of Action

The HIV virus attaches itself to a type of white blood cell known as a CD4+ T lymphocyte, which it then uses to replicate and spread. The drugs used in ART can interfere with this process at various stages:

1. Inhibition of reverse transcriptase
   This prevents the virus from converting its RNA into DNA and integrating it into the host cell's genome.
2. Inhibition of proviral DNA integration
   This stops the production of new viral proteins.
3. Inhibition of assembly and release of viral particles
   This halts the formation of new viruses.

The use of a combination of drugs, each with a different mechanism of action, is preferred over monotherapy. This approach, known as combination antiretroviral therapy (cART), helps to suppress viral replication more effectively, slow down the development of drug resistance, and target different cellular or tissue reservoirs of the virus.

When to Start and How to Monitor

The decision to start ART is usually based on the number of CD4+ lymphocytes (a measure of immune system health) and the level of viral replication (viremia). Changes in therapy are considered when viral replication resumes, especially if accompanied by a decrease in CD4 count or clinical deterioration.

To monitor disease progression and the effectiveness of therapy, several markers are used. These include:

• Virological indicators
  These measure the degree of viral replication. A commonly used marker is plasma viremia.
• Immunological indicators
  These assess the state of immune deficiency. The number of CD4+ T lymphocytes, which decreases during the chronic phase of the infection, is a key marker.
• Clinical markers
  These include signs and symptoms such as oral candidiasis, herpes zoster, weight loss, and persistent low-grade fever.

The CD4 lymphocyte count is considered the most reliable marker for monitoring disease progression and the effectiveness of therapy.

Beyond Antiretroviral Therapy

While antiretroviral therapy (ART) remains the cornerstone of HIV treatment, effective management of HIV infection requires a broader, more comprehensive approach. Care extends beyond viral suppression and includes:

• Prevention and treatment of opportunistic infections (OIs):
  People with weakened immune systems are more vulnerable to infections such as tuberculosis, pneumocystis pneumonia, and candidiasis. Prophylactic medications, timely vaccinations, and early treatment are essential to reduce morbidity and mortality.
• Management of HIV-related cancers
  Certain malignancies, such as Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and cervical cancer, are more common among people living with HIV. Regular screenings, early detection, and appropriate oncological treatments are important parts of care.
• Supportive and adjunct therapies
  Nutritional support, mental health care, pain management, and physical rehabilitation can greatly improve overall well-being. Counseling and social support services also help patients cope with stigma, stress, and long-term treatment adherence.
• Lifestyle and preventive care
  Encouraging physical activity, balanced nutrition, smoking cessation, and moderation of alcohol use contribute to maintaining a stronger immune system and reducing the risk of comorbidities such as cardiovascular disease and diabetes.

In conclusion, the treatment of HIV infection is a complex process that requires a combination of therapies tailored to the individual's disease stage and overall health status. Regular monitoring is essential to assess the effectiveness of the treatment and make necessary adjustments. With appropriate therapy, people with HIV can lead a healthy and productive life.