Antiretroviral therapy or ART or COCKTAIL. When he arrived, he turned the tables. What was known about AIDS, in those days, of the inexorable fatality, began to change.
Not everyone ... and I repeat, not everyone, could benefit from the outset, and even today, not everyone can. For those who couldn't, it was because AIDS had gone too far, caused too much damage and left too little force for combat. For those who couldn't today, the reason is the same. The advance of the disease. The silent and treacherous advance. If you have only one reason to believe you may have HIV, get tested.
Do the test
The test, the early treatment and his firm intentions change this game. Or not! It always depends and a lot on you!
This is the big point to be understood in our lives! How we got to the point of having an undetectable viral load and, with some hope, we are no longer transmitters. About this I have my doubts, fears, afflictions. But we need to keep in mind and understand that…
Not! Love does not immunize!
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… Antiretroviral Therapy - Somehow it is what keeps us alive…
… It is very important for us! It is what prevents the evolution from HIV infection to AIDS.
Antiretroviral Therapy Things to Learn
When I received my diagnosis there was a perennial reality:
There was no treatment, there was no hope of getting treatment, and the damn disease was fatal. If you read the story of Beto Volpe, Death and Positive Life, you will see how difficult it was for him! For us!
The terror I experienced was indescribable. That thing I wrote about being afraid of being like a plant, maybe a fern, alone, drying, in a vase was the result of what I saw happen with the first people I saw there, at CRT-A, on Rua Antônio Carlos .
Do you know the logic of the ORLOFF effect? It's this one:
"I am you tomorrow"!
It was the advertisement for a certain Vodka, the one by Orloff. I don't get pi *** for writing their names here, but they created an interesting thing, because advertising, and I'm going to take the hook and enjoy it well, spoke of the hangover of Vodka which, they say, as well as that of liquor of eggs, could justify euthanasia; pilaria of Luiz Fernando Veríssimo ”.
The idea was to say that this Vodka did not give a hangover. If you read me, and you are a person living with HIV and drink, stop!
The drink and antiretroviral therapy (TARV OR COCKTAIL) do not match, because the blessed liver will work double. Tenfold because of the medication and, by not drinking, you do him a great favor, his liver, one of the great sacrifices in this thing.
Returning to the treatment, to the inexistence of it, all that was seen was organic degeneration. Every person I saw in a day. We did tests to see and see how much we got worse. That's what we did for viral load tests!
My Personal Fear Was Dry like a plant in a pot without water
I terrified myself in the other, just as I was terrified of “ending my days as Waldir".
Withered, sucked by pain, physical, debilitated, incapacitated and cachectic. A human ruin.
Combined cocktail therapy
HIV is typically composed of a primary viral type (called a “wild type” virus), as well as a multitude of viruses, each with unique genetic signatures and conformations. A combination of antiretroviral drugs (which inhibit two or more stages of the life cycle) is used to suppress as many of these variants as possible at a point where a person's viral load is considered undetectable.
When used in combination, antiretroviral drugs act as a kind of biochemical "tag team". If drug A, for example, is unable to suppress a variant by suppressing a stage in the life cycle, then drug B and C can usually complete the job by attacking a different stage.
As a result, HIV's ability to replicate is almost completely disrupted, with only a few mutant viruses able to escape and circulate freely in the bloodstream.
It is generally recommended that three different drugs from two different classes be prescribed.3 The genetic resistance test is used by doctors to help identify the types and degrees of mutations that exist within their viral population, which helps them determine which combination of drugs is likely to work best for a specific situation.
The goal is not only to achieve viral control, but also to overcome any drug-resistant mutations that may exist within the viral population.
Why can't antiretrovirals cure HIV? The Reservoirs.
A subset of the virus, called for the virus, is able to incorporate itself into cells and tissues in the body known as latent reservoirs. Instead of replicating and emerging from infected cells, the proviral HIV divides and replicates with the host cell, undetected by the immune system. It can remain in this state for years and even decades, only to resurface when treatment is stopped or shown to be ineffective.
Until scientists are able to "kick" the virus out of these hidden reservoirs and into body fluids, the ability of any agent to completely eradicate HIV is unlikely, if not impossible.
Starting Antiretroviral Therapy
In May 2014, the US Department of Health and Human Services (HHS) revised its HIV treatment guidelines, recommending the implementation of therapy in all adults diagnosed with HIV, regardless of count CD4 or disease stage.4 In the past, treatment was only recommended when a person's CD4 count fell below the threshold of 500 cells / mL.
The HHS decision was supported by evidence that early treatment is associated with a number of positive outcomes, including:
- Reduced risk of diseases associated with HIV infection
- Reduced risk of mother-to-child transmission
- Reduced risk of HIV transmission
This latter recommendation is further supported by evidence that antiretroviral therapy can significantly reduce the infectivity of a person living with HIV, a strategy known as treatment as prevention (or TasP). It has also been shown that people who receive early HIV therapy are 53% less likely to develop serious illnesses, both HIV-related and non-HIV.
In contrast, postponing treatment until a person's CD4 count drops below 200 (the stage of the disease known as AIDS) can reduce that person's life expectancy by an average of 15 years.
Choosing appropriate drugs (MEDICINES)
The goal of first-line therapy is to prescribe drugs that will provide the simplest dosing schedule, the fewest side effects and the lowest risk for developing drug resistance. While treatment guidelines will change and evolve regularly with the release of new drugs or scientific information, the current body of science advocates the use of integral inhibitors new generation and nucleoside analogues in first-line therapy.
Among the 39 FDA-approved antiretrovirals are 12 fixed dose combinations (FDC) that contain two or more drugs. With this, you only have to take one pill (as opposed to several) daily, which can make following your treatment plan simpler.
Examples of combined fixed-dose drugs include:
- Atripla (Sustiva, Viread, Emtriva)
- Complera (Edurant, Viread, Emtriva)
- Genvoya (Vitekta, Tybost, tenofovir alafenamide, Emtriva)
- Odefsey (Edurant, tenofovir alafenamide, Emtriva)
- Prezcobix (Prezista, Tybost)
- Stribild (Vitekta, Tybost, Viread, Emtriva)
- Triumeq (Ziagen, Epivir, Tivicay)
- Truvada (Viread, Emtriva)
Simplify to maintain membership
Keeping the treatment plan as simple as possible is particularly important, as the current body of research suggests that people on treatment need to keep more than 95% adherence to achieve optimal therapy goals. My oldest nurse (in the sense of history) Camila explained this to me at the end of the day, early in the evening, still on Rua Frei Caneca, from where the Honorable Political Dwarf Pastel de Chuchu should never have taken the AIDS home , exterminating, without prior notice, more than six thousand (6.000) patients inside Emílio Ribas. The first time I went there, I spent over nine hours (NINE HOURS) in the queue, to get my medications and Mara's. Camila said the goal was 95%.
Two seconds later, having realized that I was being beaten like a cow in the garden to do the math, she smiled and said:
- "Lose, at most, one outlet".
I administer both treatments with Spartan discipline, draconian rigor and Teutonic fist! Our goal is 100%. Well, let's go ahead.
HIV treatment - Adherence is everything, everything, everything and more!
Taking your medications exactly as prescribed, without missing a dose, is the best way to achieve the best results and minimize treatment failure.
If a treatment fails
In general, the duration of treatment effectiveness is directly associated with the rate of compliance that a person is able to achieve.
Failure to sustain viral control allows the virus to reproduce freely, giving drug-resistant mutations the ability to thrive and become the predominant variant. When this happens, the treatment will become less and less effective and eventually it will stop working completely. This is known as treatment failure.
At this stage, doctors will need to perform genetic resistance tests to identify the extent of resistance to the drug. In some cases, resistance can affect only one or two drugs; in others, entire classes may be ineffective. The treatment will then need to be reviewed to better overcome these issues, while addressing adherence barriers that may have caused treatment failure in the first place.
Yes! There is Life With HIV
The diligent use of antiretrovirals is important. But a healthy lifestyle plays a big role in how you feel on a daily basis, as well as how your illness is managed.
Stay up to date on vaccines
HIV makes it more difficult for your body to fight infections. You can protect yourself from certain preventable diseases by staying up to date on your immunizations. Ask your doctor which vaccines are recommended for you.
Smoking when you gocyou have HIV it has a huge impact on your health and can take years out of your life. Smoking is an unhealthy habit anyway, but its health ramifications reach even more people with HIV, significantly increasing the risk of lung cancer, heart attack and stroke.
Moderate your alcohol intakes
Some studies have shown that alcohol intake can accelerate the progression of HIV, even taking antiretrovirals.9 You may want to moderate your alcohol consumption. Talk to your doctor to see what is most appropriate for you, and especially if you feel you need help with your drink.
Parallel therapies that help
Over-the-counter medications do not treat the virus itself, but are useful in reducing certain problematic symptoms and complications of the disease.
Among some options to consider:
- Over-the-counter painkillers, like acetaminophen, can help relieve headaches and body aches.
- Topical capsaicin can be used to peripheral neuropathic pain.
- Vitamin D and calcium: Antiretroviral therapy can cause a reduction in bone density, leaving you more at risk for developing osteoporosis. These supplements can help maintain bone strength.
Complementary Alternative Medicine
There are no CAM therapies that take the place of antiretroviral therapy. That said, many people with HIV turn to alternative medicine as a way to manage the symptoms of the disease and the side effects of treatment drugs. You should always speak to your doctor before adding anything to your treatment plan.
Yoga or Meditation
Yoga and meditation can help to relieve pain, as well as relieve feelings of stress and depression that often come with an HIV diagnosis.10 An additional benefit of yoga is that it is a gentle way to exercise.
Alpha Lipoic Acid
Although not widely studied for HIV pain, alpha lipoic acid has been shown to improve diabetic nerve pain.11 As such, it can be useful in managing neuropathic pain for those with HIV as well.
Medical marijuana can help with pain, reduce nausea and stimulate appetite.12 There are disadvantages, however, including the possibility of addiction. In addition, state laws vary widely when it comes to medical marijuana.
Herbal supplements to prevent
While some herbal supplements are safe to use during treatment, others may interact negatively with antiretrovirals. Because of this, certain herbs like St. John's wort, garlic (only supplements, cooking is OK), gingo biloba, ginseng, kava, goldenseal, and evening primrose oil should be avoided.13 This should not be considered an exhaustive list; always talk to your doctor first before starting any herbal supplement.
Translated by Cláudio Souza on September 29, 2020 from the original in Verywellhealth Reviewed by Mara TM