A couple of decades after AIDS exploded, a cure is still a mirage. At best, medications slow the disease and keep debilitating infections at bay. Early detection and timely intervention are still the best recourse. The focus of most treatments is to boost the immune system, reduce stress, ensure healthy nutrition and a regular exercise regimen.
Increasingly, however, voices are ricocheting in the medical fraternity that conventional medications do more harm than good. As is well known, while subjugating targeted diseases, antibiotics and steroids damage the body`s immune system. More and more people are now taking recourse to alternative therapies that take a holistic view of the disease and seek to rejuvenate the body`s natural defenses. Many are also utilizing alternative therapies in conjunction with allopathy.
Although the hunt for a vaccine is hotting up, presently there is no cure for AIDS. Current treatments, however, seek to improve the quality of life of people with AIDS (PWAs). A current popular treatment involves a "triple-cocktail" approach, also known as the highly active antiretroviral therapy (HAART), which uses three different drugs to combat the infection. These medications are two nucleoside analog drugs, such as AZT and 3TC, and a protease inhibitor, such as Crixivan or Ritonavir. Protease is an enzyme needed for HIV replication; a protease inhibitor stops protease from working. The drugs reduce the concentration of viruses in the bloodstream to low, even undetectable levels.
So far, the combination HAART treatment is the closest thing medical science has to an effective therapy. The key to its success in some patients lies in the drug combination`s ability to disrupt HIV at different stages in its replication. Reverse transcriptase inhibitors, which usually make up two drugs in the HAART regimen, restrain an enzyme crucial to an early stage of HIV duplication. Protease inhibitors hold back another enzyme that functions near the end of the HIV replication process. The combination can be prescribed to those newly infected with the virus, as well as AIDS patients.
FDA approved the first drug specifically to combat HIV and AIDS in 1987. Commonly known as AZT (zidovudine), it is in the family of reverse transcriptase inhibitors called nucleoside analogs. Protease inhibitors, the last part of the triple cocktail, have only been on the market about three years. FDA approved the first one, Invirase (saquinavir), in late 1995. Others approved since include Norvir (ritonavir), Crixivan (indinavir), Viracept (nelfinavir), and Agenerase (amprenivir). Viracept was the first of its class to be labeled for use in children and adults. Norvir and Agenerase are now approved for children as well. FDA also has approved Fortovase, a new formulation of saquinavir that comes in a soft gelatin capsule that allows more drug to be absorbed into the body than the earlier version.
Drawbacks of the Regimen
Though the use of protease inhibitors with other AIDS drugs has had a drastic impact on the health of HIV and AIDS patients, there are drawbacks. The HAART treatment is not an AIDS cure, says FDA`s Klein. Though HIV, the virus that causes AIDS, may not be detectable in the blood following successful HAART treatment, experts generally feel that the virus is still present, lurking in hiding spots such as the lymph nodes, the brain, testes, and the retina.
"The improved sense of well-being, and the belief that lower viral load means they will not transmit the virus, has translated, in some communities, to a lapse in certain prevention practices," Klein says. He adds that this is dangerous because infected people, even with diminished viral counts, can spread the virus.
Another concern is that the combination therapy, besides being very expensive, requires a much more complicated treatment regimen. "Patients need to stay aware of and adhere to their dosing schedule," says Klein. "If not taken on a strict regimen, protease inhibitors can result in the emergence of HIV strains that are resistant to treatment." Numerous studies also have shown that viral load can rapidly "rebound" to high levels if patients discontinue part or the entire triple therapy regimen.
AIDS treatments may interact with many commonly prescribed drugs. For example, Pfizer Inc. plans to label its impotence drug Viagra to warn of possible interactions with certain protease inhibitors, which appear to raise levels of Viagra in the blood.
AIDS drugs also may prompt onset of diabetes or a worsening of existing diabetes and hyperglycemia (high blood sugar), along with increased bleeding in people with hemophilia types A or B.
Common side effects of taking protease inhibitors may include nausea, diarrhea, headache, kidney stones and serious drug interactions. Protease inhibitors may also cause unusual fat deposits, such as in the back of the neck, and high levels of fats and cholesterol in the bloodstream.
Some patients on triple therapy have experienced a type of weight redistribution where face and limbs become thin while breasts, stomach or neck enlarges. Some have nicknamed the appearance of fat deposits at the back of the shoulders "buffalo hump." Fat deposits in the midsection are sometimes called "Crix belly," after the drug Crixivan, "although it has been seen in people taking all approved protease inhibitors," says Klein.
Research is currently under way to determine if protease inhibitors cause a permanent change in fat metabolism.
Pregnant Woman & Children
In 1998 recommendations, the Public Health Service Task Force stated that the decision to take anti-HIV drugs during pregnancy should be made by the pregnant woman after her health care-provider has explained benefits and risks. There are some compelling reasons to take the drugs. For example, an HIV-positive pregnant woman who takes AZT after the first trimester decreases the chance of the baby being born with HIV. Studies show that AZT taken according to a strict regimen decreases by nearly 66 percent the odds of infecting the newborn.
The task force says women should consider delaying therapy until after the 10th to 12th week of pregnancy, after the fetus`s organs have gone through their most rapid development. This delay may minimize any adverse effects of AZT on fetal development, but it needs to be balanced with the health of the mother and possible transmission of HIV to the fetus.
Most children with HIV became infected from their mothers near the time of birth. This means that for many babies, treatment can be started soon after birth. Federal guidelines recommend that all HIV-infected children younger than 1 year and all HIV-infected children of any age with symptoms of HIV infection or evidence of immune suppression be treated with anti-HIV drugs. For HIV-infected children with no symptoms, therapy can be deferred if risk of disease is considered low based on viral load and immune status.
Triple combination therapy can be used for all HIV-infected infants, children and adolescents treated with HIV drugs. Infants during the first six weeks of life who have been exposed to HIV but whose HIV status is unknown can be treated with AZT as sole therapy. Infants diagnosed with HIV while receiving AZT alone should be switched to combination therapy.
Aids Related Illnesses
Because AIDS patients have suppressed immune systems, they can fall prey to certain illnesses that people with healthy immune responses don`t get, or get only very rarely. One common such illness is Pneumocystis carinii pneumonia (PCP), which can be life-threatening. Treatments to prevent PCP are NebuPent (aerosolized pentamidine), a fine mist inhaler, and drugs such as Bactrim and Septra that contain both trimethoprim and sulfa. Mepron (atovaquone) is approved for treating mild-to-moderate PCP in pregnant women and patients who cannot tolerate standard treatment. Neutrexin (trimexetrate glucoronate) also is approved for pregnant women and for moderate-to-severe PCP when given with Leucovorin (folinic acid).
Cytomegalovirus retinitis is a potentially severe AIDS-related eye infection that can lead to blindness. Approved treatments include ganciclovir, marketed as Cytpinkovene in oral dosage and as Vitrosert as an implant, Foscavir (foscarnet), and Vistide (cidovir).
Kaposi`s sarcoma (KS) is a type of AIDS-related cancer that causes characteristic purple or skin tumors that are flat or slightly raised. Intron. For such type of cancer there are several treatments. These include radiation, surgery, cryotherapy or freezing of individual lesions, and injecting lesions with anti-cancer drugs.
A (human interferon-alpha), doxorubicin liposome injection, or daunorubicin citrate liposome injection can be used to treat KS. Panretin, a topical gel, also is approved for treating certain types of KS lesions.
AIDS wasting syndrome involves major weight loss, chronic diarrhea or weakness, and constant or intermittent fever for at least 30 days. Approved treatments include Marinol (dronabinol), Megace (megestrol), and Serostim (somatropin rDNA for injection).
To treat anemia and low white blood cell counts associated with AIDS, hematopoietic stimulating factors are sometimes used.
One of the key strategies in combating HIV is early detection. People who suspect they are infected should immediately go in for an HIV test. The earlier the treatment begins, the longer the chances of survival. Treatment usually begins with multiple drugs to contain the virus. Thereafter, viral levels are regularly monitored to spot changes in disease progression. This allows doctors to alter their prescribed regimens accordingly, for the best results.
The patient should also ensure that s/he fosters excellent hygiene habits to keep opportunistic infections at bay. The proper lifestyle changes, healthy activities and good nutrition are other ways of ensuring the disease progression is slowed or halted.
On the patient`s part, excellent hygiene habits, lifestyle changes, healthy activities and good nutrition also help to contain AIDS. Once the disease enters the terminal stage, death is almost certain. In such circumstances, alleviating the suffering of patients is of primary concern. Patients are then advised to join support groups where members share common experiences.
According to researchers, even amongst all the research activity, we still may be many years away from finding a possible cure for AIDS. Because of advances in treatment, the number of AIDS cases in the USA and Canada has been dropping, but the disease continues to grow virtually unchecked in some countries.
Earlier, the progression of HIV was gauged through T-cell counts. Tests now measure the virus directly through a blood test, a much better indicator of the rate of HIV replication. This is done by checking the viral load (the number of particles in a blood sample)-directly proportional to the level of replication-that pinpoints HIV activity in a person`s body.
HIV antibodies are detectable only three weeks to six months after the first infection. This invisible period is termed the `window period`. Any tests undertaken during this period may be negative even if the person is infected.
The ELISA (Enzyme-Linked Immunosorbent Assay) Test
There is no test per se to detect AIDS. Prevalent tests simply detect the presence of HIV antibodies in human blood, which our bodies produce to fight the invader. The ELISA, the Rapid Simple and the Western Blot tests are currently used to detect HIV. Among these, the ELISA (Enzyme-Linked Immunosorbent Assay) is the most common screening test. After a person tests positive for this, it`s repeated to double-check the result. When an ELISA test yields two or more positive results, the Western blot is used to confirm these results, which is more specific than the ELISA. The two tests combined are more than 99.9 per cent accurate.
To circumvent the Window period, America`s Centres for Disease Control and Prevention (CDC) recommends getting tested six months after the last possible exposure to the virus. The CDC also stresses the importance of protecting oneself and others from further possible exposures to HIV during the six months between exposure and the test.
Additionally, CDC recommends that pregnant women also be tested for HIV. This ensures that, if HIV positive, a woman can take medications to lower the chance of passing HIV to her child before, during, or after birth. Sans medical treatment, an infected mother`s child has a 25 percent chance of being born with HIV. Medical treatment with AZT (also known as zidovudine or Retrovir) during pregnancy and labor dramatically reduces the risk of transmission from mother to baby.
Saliva and Other Tests
Besides blood tests, urine and saliva tests are also used to detect HIV. Some doctors voice reservations about the efficacy of saliva tests contending that although saliva contains some virus components, these may not be sufficient for transmission. The marketers of the saliva kit, however, claim that a study by the Thai Red Cross found that results of blood tests and saliva-kit tests were identical. Besides, the kits are said to be popular amongst a majority of American states as they are easy to use, cheap, portable and call for minimal training of employees. The biggest advantage these kits have over blood tests is the safety of medical personnel, since they obviate the use of needles and the drawing of blood.
In terminal illnesses such as cancer and AIDS, hospice care centers are indispensable. In fact, hospice care is an ancient concept practiced under ayurveda for millennia. The prime aim is to provide a sanatorium-like ambiance for patients, which facilitates a life free of prejudice and discrimination. Patients at a hospice care center can avail of subsidized or free medicines depending on their pecuniary status.
With its comprehensive array of medical and social services, hospice strives to meet each patient`s unique physical, emotional, social and spiritual needs, as well as the special needs of the patient`s family and close friends. The goals of hospice are to keep the patient as comfortable as possible by relieving pain and other discomforting symptoms; to prepare for a death that follows the wishes and needs of the patient; and to reassure both patient and family members by helping them to understand and manage what is happening. This support assists patients and families through the process of facing, understanding and accepting death.
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AIDS stands for acquired immunodeficiency syndrome. A diagnosis of AIDS is made by a physician using certain clinical or laboratory standards.
American Institute of Preventive Medicine