HIV/AIDS: Treatment and Your Sexual Health

Acquired immunodeficiency syndrome (AIDS) is a chronic disease caused by HIV (human immunodeficiency virus) that damages your immune system, thus, reducing your body's ability to fight infection and disease. It is considered a rare condition in the United States with fewer than 200,000 new cases per year.

There is no cure for HIV/AIDS, but there have been remarkable improvements in medications and treatment over the past few decades whereby the infection can be controlled and disease progression can be prevented.

The virus spreads by sexual contact and may cause flu-like symptoms two to four weeks after infection. If infected, you may not present symptoms, but after eight to 10 years, if left untreated, HIV typically becomes AIDS.

The most important strategy is to get tested regularly if you're at risk and to get an early diagnosis. Let's examine the various treatment options, how much they cost and how HIV impacts your sexual and reproductive health.

Treatment options

The guiding principles of HIV treatment are to be highly effective, prescribed in fewer doses with fewer side effects. Significant improvements have been made in all of these areas over the years. There is still no cure for HIV, but with the right treatment, you can stay healthy and gradually reduce the amount of HIV in your body until undetectable and untransmittable (known as U=U).

HIV is treated with antiretroviral medicines. These are designed to stop the virus from replicating in the body, allowing the immune system to repair itself and, thus, prevent further damage. Treatment involves taking a combination of HIV medicines daily, known as a treatment regimen. People with HIV should start taking HIV medicines as soon as possible after an HIV diagnosis.

"If a person is responsive to the medication, they should start seeing total viral suppression, followed by immune system recovery, within three to four months, sometimes up to six," noted Michael Horberg, M.D., M.A.S., director of HIV/AIDS and STD at the Kaiser Permanente and Care Management Institute, based in Washington, D.C.

There are more than 30 HIV medicines approved by the Food and Drug Administration. Your HIV medicine regimen depends on your individual circumstances and needs, and your healthcare provider can talk you through all the options and what's right for you.

"It's really important the patient goes to an experienced physician, one that they're comfortable with, to establish the correct regimen," Horberg added. "And then it's a partnership for adherence."

The types of HIV medication include:

• Nucleoside reverse transcriptase inhibitors (NRTIs). These work by blocking reverse transcriptase, an enzyme that HIV needs to make copies of itself. This drug stops HIV from replicating inside your body.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs). These bind to and alter reverse transcriptase to prevent HIV from replicating.
• Protease inhibitors. These block the enzyme protease, which is also needed for HIV to replicate.
• Fusion inhibitors. These stop HIV from entering the CD4 T lymphocyte cells of the immune system.
• CCR5 antagonists. These block receptors called CCR5 coreceptors, which are found on the surface of certain immune cells. HIV needs to use these receptors to enter cells, but it can't do that if they're blocked.
• Integrase strand transfer inhibitors (INSTIs). These block integrase, another enzyme that HIV needs to replicate.
• Attachment inhibitors. These bind to the gp120 protein found on the surface of HIV and prevent HIV from entering CD4 cells.
• Postattachment inhibitors. These block CD4 receptors, preventing HIV from entering specific immune cells.
• Pharmacokinetic enhancers. These increase the effectiveness of HIV medicine.
• Combination HIV medicines. Two or more HIV medicines are combined for more effective treatment.

HIV medication comes in both pill and injection form, although pills are recommended for people beginning a treatment regimen, according to the Centers for Disease Control and Prevention (CDC). Once a person has an undetectable viral load or has been virally suppressed for at least three months, they can move on to injections either monthly or bimonthly, depending on the HIV treatment regimen.

As there are so many different treatment options for HIV, there's a wide range of side effects that can happen. It's also possible for some people to get side effects from a drug while others don't. Common side effects include rash, diarrhea, nausea, fatigue, headaches and sleeping difficulties. Longer-term side effects of some HIV medications can include high cholesterol or disturbances in the functioning of the liver or kidneys.

Most side effects from HIV medication are relatively slight and not everyone experiences them. However, Horberg stressed the importance of working closely with your healthcare provider and reporting side effects.

"If it's getting harder for you to take the meds due to side effects, talk to your physician about it," he added. "Sometimes it may be trial and error. Maybe the first drug you went on caused a side effect. But it's not the 1990s anymore. There are many other options you can switch to."

Paying for HIV treatment

Antiviral HIV drugs can be expensive, though generic medicine is often cheaper than marketed, brand-name drugs. You can usually take advantage of prescription insurance or an assistance program to pay for the bills.

If you have private insurance, it may cover the cost of your HIV medication. However, you'll still need to pay any deductibles, copayments and coinsurance your plan requires. The level of coverage you are eligible for depends on your individual insurance plan.

Medicaid is the largest public health insurance program in the U.S. and it covers people with low incomes, older people, people with disabilities, and some families and children. Eligibility rules differ from state to state, but it is often an essential source of coverage for many people living with HIV.

Other federal programs may help, such as those for women and children, veterans, or American Indian and Alaska Native people.

If you aren't eligible for any federal assistance, then it may be possible to get help from a patient assistance program (PAP). Pharmaceutical companies offer these programs to low-income people living with HIV who are uninsured or underinsured and do not qualify for federal assistance programs.

"Most states have access to federally funded programs AIDS drug assistance programs that help people with limited or no prescription drug coverage," Horberg explained. "But to say that for a lot of patients the cost is zero would be inaccurate."

HIV/AIDS and sexual health

Alicia Morehead-Gee, M.D., medical director of HIV prevention at AltaMed Health Services in Los Angeles, advised that the treatment for HIV can suppress the virus in your system, leading you to have an "undetectable" viral load, meaning the virus cannot be detected through lab testing.

"If you have an undetectable viral load, you cannot pass HIV onto other people through sexual activity," she said. "This is known as U equals U, aka undetectable equals untransmittable. We do recommend discussing your HIV status with your sexual partners so that they are aware and can discuss any risks with their healthcare providers."

"The best way to prevent transmission is for the person with HIV to be really adherent to their meds and get their viral load to undetectable because then it's not transmittable," Horberg added.

Morehead-Gee said people with HIV-positive sexual partners are eligible for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to further decrease the chances of HIV transmission.

"For most people, PEP and PrEP is simply [taking pills] once a day that are now generic," Horberg said. "So it's actually very, very inexpensive. But we always try to remind my patients, both with and without HIV, that PEP and PrEP only prevent or treat HIV. It's not going to prevent STDs like gonorrhea, syphilis or chlamydia."

HIV/AIDS and reproductive health

If you are HIV-positive and pregnant, it's vital to consult an HIV specialist regarding your treatment options before, during and after pregnancy. It's critical to be monitored carefully throughout your pregnancy because there can be an increased risk of preterm birth, preeclampsia, intrauterine growth restriction and stillbirth.

If one or both partners in a relationship have HIV, passing the infection to their newborn can be a concern. However, there are individuals living with HIV who have HIV-negative children because of ongoing treatment. Morehead-Gee noted the vast majority of HIV treatment options are safe during pregnancy.

Horberg advised if you are a pregnant woman with HIV, it is paramount to get your viral load completely down to help assure a better pregnancy experience.

"You can have a safe pregnancy while taking HIV treatment," Morehead-Gee explained. "Taking HIV treatment during pregnancy protects the fetus from getting HIV."

Editor's note: This report is part 3 of a five-piece introduction and continuing update focusing on HIV/AIDS. Check out the other parts of this series:

1. HIV/AIDS: The Basics You Need to Know
2. HIV/AIDS: Signs, Symptoms and Diagnosis
3. HIV/AIDS: Treatment and Your Sexual Health
4. HIV/AIDS: Living and Loving Your Best Life
5. HIV/AIDS: Back to the Future