Download Antiretrovirals

A mak
hambi ok
ulw
a nengcu
laza A nti-retrov
ir
al treat
men
t
makhambi
oku
lwa
nengculaza
ti-retrovir
iral
treatmen
ment
1
Treatment for AIDS
There are now medicines which can
treat AIDS. They are called antiretrovirals, or ARVs for short. ARVs
do not cure HIV! But they can stop a
person with HIV from dying of AIDS.
ARVs only work if you use them
properly. ARVs do not work for
everybody. They are already
There is a lot of confusion
about these medicines
which fight AIDS.
Who do we believe?
working well for many people.
For the next eight weeks we will give
you more information about ARVs. We
will tell you:
Some people say ARVs are
dangerous poisons. They say
ARVs will make you sicker and
kill you quickly. (It is true that
ARVs can cause serious health
problems if they are not used
properly! But this is also true of
many other medicines we use
all the time.)
z What ARV drugs are, and what
they do in the body
Other people say ARVs save lives.
It is true that many people who
were close to dying of AIDS are
healthy again thanks to ARVs. (In
rich countries, HIV is no longer a
disease that kills, but rather a
health condition you can treat
and live with, like diabetes or
high blood pressure. This is
because people with HIV in rich
countries can get ARVs easily.)
z understanding the side effects of
ARVs
z when to start taking ARVs
Our government now gives ARV treatment to those who
z understanding how ARVs can stop
working after a while (drug
resistance)
need it. In this time of HIV and AIDS, it is important to know
the truth about ARVs.
z sticking to the treatment
What do ARVs do?
HIV grows in the blood, killing the important CD4
If the person stops taking the ARVs, the HIV will
cells which help the body to fight sicknesses. ARVs
get strong again. The new strong HIV knows ARV
are medicines which stop HIV killing CD4 cells
medicines. HIV can disguise itself and escape from
and growing in the blood. This means the blood
the ARVs. This means the ARVs do not work well
gets strong again and can fight off the infections
anymore.
that make people with HIV sick. HIV stays in the
blood but the ARVs keep it weak, protecting CD4
cells.
Ne
xt w
ee
k: The stages of HIV, CD4 cells and the viral load
Next
wee
eek:
A mak
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ir
al treat
men
t
makhambi
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ti-retrovir
iral
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2
The stages of HIV infection
Doctors talk about four stages of HIV infection.
Stage 2
Stage 1
Skin problems, colds
and flu, losing weight
Few or no signs
of illness
It usually takes many years to go
Stage 3
Stage 4
Very thin, diarrhoea,
fever, thrush, lung
infections like
pneumonia and TB
Serious lung infections and
thrush in the foodpipe
(oesophagus); TB outside the
lungs (such as in the glands)
brain infections; bad
diarrhoea, cancers (Karposi’s
Sarcoma). All these illnesses
together are AIDS.
from Stage 1 to Stage 4.
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
Counting CD4 cells and HIV in the blood
Doctors do blood tests to find out what stage of
HIV infection a person is at. They measure the
number of CD4 cells in the blood, this is called
a ‘CD4 count’.
They also measure the amount of HIV in the
blood, called the ‘viral load’.
A person with a high viral load usually has a low
count. This means that the HIV is taking over
CD4 count
the body and is killing CD4 cells fast.
A normal CD4 count for an adult is from
500 to 1200 cells per millilitre. A healthy
person with a strong immune system has
a lot of CD4 cells in his or her blood. A
person who has a weak immune system
has not enough CD4 cells in his or her
blood. A CD4 count of lower than 200
means the person is getting to Stage 4,
that is AIDS.
The road from HIV to AIDS
Isigaba
sokuqala
Isigaba sesibili
Isigaba
sesithathu
Isigaba
sesine
CD
4c
ou
nt
AIDS
Viral load
Kusukela eminyakeni ewu-5 kuya kwewu-10
People with HIV who go to the clinic or hospital
regularly get used to these tests. They need to
understand what CD4 count and the viral load tests
mean.
When a person starts taking ARVs, doctors use these
tests regularly to check how well the ARVs are
working.
Next week: How ARV medicines change
the viral load and the CD4 count
A mak
hambi ok
ulw
a nengcu
laza A nti-retrov
ir
al treat
men
t
makhambi
oku
lwa
nengculaza
ti-retrovir
iral
treatmen
ment
How ARVs change the viral
load and the CD4 count
3
Last week we wrote about the amount of HIV in the blood (viral load)
and the number of CD4 cells in the blood (CD4 count). These blood
tests show which stage of HIV or AIDS a person is at.
The HIV virus cannot make more viruses by itself.
After it gets into our blood in our body, it takes over
the white blood cells called CD4 cells. It uses the CD4
cells to make more HIV viruses. The CD4 cells then
die. Without enough CD4 cells, the body can’t fight
germs anymore.
Inside your body, in the CD4
blood cells, HIV makes
10 bi
llion new HIV viruses
billion
every day!
ARVs work here, in the CD4
cell, to stop HIV from
making more viruses.
H IV
HI V
How ARVs work
How HIV learns to fight ARVs
ARVs stop HIV from making more HIV viruses inside
the CD4 cells. The body can now make more CD4
cells and be able to fight off germs again.
HIV is a clever virus. If we do not take our ARVs every
day at the right times, HIV soon learns to disguise
itself (develops resistance). The ARVs don’t recognise
the HIV anymore, so they do not work anymore.
Some HIV viruses hide quietly in the body, not
making new viruses. ARVs only work when HIV is
making new viruses. This means we can never get rid
of all the HIV viruses in the body.
When someone takes ARVs the viral load (amount of
HIV in the blood) goes down very quickly. It can go
down from thousands of viruses in the blood to less
than 400 in six months. The CD4 count goes up more
slowly, from less than 200 to more than 500.
HIV can make millions of new HIVs in your blood
very quickly. If you forget to take your ARV medicine
once, the HIV has a chance to make millions of new
viruses in that short time. Many of these new HIVs
will be the ones that the ARVs do not recognise.
Anyone who takes ARVs must understand this very
well. We will write more about drug resistance later.
Next week: The different types of ARV medicines
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a nengcu
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ir
al treat
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t
makhambi
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ti-retrovir
iral
treatmen
ment
The different types of
ARV medicines
4
There are three different types of ARV drugs which
fight HIV in different ways. Because it is easy for HIV
to disguise itself and resist the ARV drugs, people
must take the three different types of ARV drugs all
at the same time. This is called HAART (Highly
Active Antiretroviral Therapy) or ‘triple therapy’.
ARV drugs must be
taken every day at the
right time. Miss only a
few doses and clever
HIV learns to fight
these medicines.
There are two groups of HAART ARV drugs that the
government uses in South Africa. Healthworkers call
these groups ‘regimens
regimens’. These are the names of the
regimens
drugs in the two regimens:
Group 1 or Regimen 1
z 3TC or Lamivudine
z d4T or Stavudine
z Efavirenz (or Nevirapine, which is safe for
women who may want to fall pregnant)
ARVs have different names, depending on which drug
company makes them. The names given on this page
are the generic names of the contents of the drugs.
(Other kinds of drugs also use different names for the
same thing. For example, paracetamol is sold by
different drug companies as Panado, Painamol,
Tylenol, or Dolorol.)
Group 2 or Regimen 2
(for those whose HIV resists Regimen 1)
z AZT or Zidovudine
z ddl or Didanosine
z Lopinavir with Rittonavir
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Side effects – when medicines
make us feel sick
Medicines that are meant to help us sometimes
give us other problems. For example, aspirin
(Disprin) can cure a headache, but it can also
damage your stomach. The bad effects that some
medicines have are called side effects
effects.
Your health worker
People who take ARVs must visit the same health
worker regularly. This means the health worker
knows all about the patient and their problems.
This makes it easier to sort out problems like side
effects. It is also nicer for the patient and the
health worker if they know and trust each other.
If a patient sees a different health worker each
ARVs do have side effects. Most of these are not
time they come to the clinic, there is more chance
very serious, but some can be dangerous.
for confusion about what medicines the patient is
Everyone who starts taking ARVs needs to know
taking, and what blood tests have been done,
what the side effects are. If they have any
and so on.
problems they must go back to the doctor or clinic
straight away.
Ne
xt w
ee
k: The different side effects of ARVs
Next
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eek:
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iral
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The side effects of ARVs
5
These are the important side effects to know about:
1. ARVs change the way other medicines
work.
Medicine for TB and epilepsy do not mix well with
ARVs. Tell your doctor about ALL the other
medicines you take, even headache pills, flu
medicine, vitamins, immune boosters and herbal/
traditional medicines.
2. Sometimes people taking ARVs can’t get
rid of lactic acid in the body
Too much lactic acid in the body is a serious
problem, called Lactic Acidosis. Signs are nausea,
vomiting, and stomache pain, feeling very tired,
short of breath and losing weight. A blood test
shows if Lactic Acidosis is the problem. The doctor
will treat the Lactic Acidosis, and give you different
ARV drugs.
3. Skin rashes
Skin rashes are usually caused by Nevirapine.
Usually the rash goes away by itself. If the person
also gets sores inside the mouth, they must go to the
doctor straight away.
People taking ARVs must have regular
blood tests to check for the more
serious side effects.
Many of the side effects, like nausea
and bad dreams, will go away after a few
weeks of starting ARV treatment.
If the side effects are too bad to live
with, go back to the healthworker to
report your problems with the medicines
before you stop taking the ARVs.
4. Changes in the blood
Some drugs, especially AZT, can make your blood
weak.
7. Sore feet
5. Liver damage
Some people get a burning pain in their feet.
This happens especially with ddI and d4T.
Some drugs, especially Nevirapine, can damage the
liver.
8. Nausea
6. Changes in the body’s fat
Lost of people who take ARVs feel nauseous.
Usually this gets better after a month or two.
After taking Lopinavir with Ritonavir for a long
time, a person can get too much fat in their blood.
They get a fat tummy but have thin arms, legs and
faces. Their bones may get thinner and weak.
9. Crazy Dreams
Efavirenz can cause strange dreams. Some
people feel as if they are going crazy.
Next week: When to start taking ARVs
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a nengcu
laza A nti-retrov
ir
al treat
men
t
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oku
lwa
nengculaza
ti-retrovir
iral
treatmen
ment
When to start taking
ARV drugs
Starting ARVs is never an emergency
(something to do in a rush), even if you are ill
with AIDS. You need to take time to learn about
the medicines, understand all about the
treatment and prepare yourself mentally.
6
ARV drugs must be taken
every day at the right time.
Miss only a few doses and
clever HIV learns to fight
these medicines.
Remember the stages of HIV infection:
Stage 1
Few or no signs of illness
It is not good to start taking ARVs
too soon, at Stage 1 or Stage 2.
These are the reasons why:
z In the early stages of HIV infection,
long before AIDS, ARVs do not make
much difference to a person’s health.
Stage 2
Skin problems, colds and flu, losing
weight
Stage 3
Very thin, diarrhoea, fever, thrush, lung
infections like pneumonia and TB
Stage 4
Serious lung infections, TB outside the
lungs, thrush in the foodpipe
(oesophagus), brain infections
(toxoplasmosis; cryptococcal
meningitis), very bad diarrhoea, cancers
(like Karposi’s Sarcoma). All these
illnesses together are AIDS.
z A person has to take these drugs
every day without missing a dose for
the rest of their life.
z The longer a person takes ARVs, the
more chance there is that the HIV
will get used to these medicines and
become resistant, so the ARVs stop
working. This is called ‘drug
resistance’, when HIV disguises itself
so that the ARVs do not recognise it
and can’t stop it making new viruses
in the body. Remember, every time a
person forgets to take their ARV
medicines at the right time, the HIV
gets more chance to resist the ARVs
by making many new resistant
viruses!
z Starting ARVs too early means more
time to get serious side effects.
The best time to start taking ARVs is when
9 your CD4 count is less than 200, or
9 you are at the beginning of Stage 4 of HIV disease (full-blown AIDS)
9 you also feel ready, knowing you will take these medicines forever.
Ne
xt w
ee
k: More about why ARVs can stop working (drug resistance)
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iral
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ment
When ARV drugs don’t work
7
Understand drug resistance
ARV medicines stop HIV making more HIV in the CD4
cells of the blood. When ARVs work well, there is soon
there is very little HIV left in the body.
But HIV is a very clever virus. It can change itself, so
that after a while the ARVs do not work well anymore.
The HIV learns to fight back against the ARVs. This is
called ‘drug resistance’.
Every time a person on ARVs forgets to take their
medicine on time, the HIV has a chance to escape the
ARVs and makes more viruses in the blood.
Remember, without ARVs, HIV makes 10 billion new
HIV viruses in your blood every day!
H IV
How to make sure your ARV
medicines work!
If you can prevent the HIV in your blood
from making more HIVs in your blood, then
it is much harder for the virus to change and
learn to fight against the drugs. The only
way to keep the HIV very weak is to take
every dose of the ARVs on time, for the rest
of your life.
More than 95% of the tablets must be taken
for the treatment to work well. This means if
a person misses more than one dose every
ten days
days, he or she has a much greater
chance that the ARVs will fail.
H IV
In week 4 of this series we told you about the different
groups of ARVs, called Regimen 1 and Regimen 2:
Each of these regimens (groups of drugs) are made up
of three different ARVs that fight HIV together in
different ways. This is called HAART – Highly Active
Anti-retroviral Therapy (sometimes called Triple
Therapy).
Most people on ARVs do take their
treatment on time if the mixture of drugs
they take is not too complicated, and they
really understand why it is so important to
take the medicine on time everyday.
Make sure you are taking HAART – that is,
there are three drugs in your Regimen, not
just two. (A few doctors still give only two
ARV drugs to start with, which means there
is more risk of drug resistance. )
When when HIV becomes resistant to the first group
of drugs (Regimen 1), the person can get a new group
of ARVs, Regimen 2, to try and weaken the the HIV
again. Regimen 1 is much easier to take than
Regimen 2. Regimen 1 drugs also work better than
Regimen 2. So you should try very hard to take the
first group of ARVs correctly.
But because the HIV has learned to fight one group of
ARVs, it is now easier for it to learn to fight the next
group of ARVs.
Ne
xt w
ee
k: Tips for remembering to take
Next
wee
eek:
your medicines on time
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ir
al treat
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iral
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How to remember to
take the medicine
Last week we told you how important it is to take
every dose of ARV medication, to make sure the HIV
in your body does not get a chance to make more HIV
that can fight against ARVs.
Here are some ideas that may help you or your loved
ones on ARVs remember to take their medicine
correctly.
Tell the people you live with that you
have HIV and are on ARV treatment
When the people you live with don’t
know that you have HIV, it is very
difficult to take your treatment
properly. If you hide away your
medicines, and take them secretly,
you will forget to take them on time.
If your family or housemates know about your
ARV treatment, they can help you to remember to
take it. They can also support you in many other
ways.
Make packs of the pills you must
take each day
For example, if you take pills twice a day, get two
small different coloured bottles. One bottle is your
morning pill bottle, and the other is your evening
pill bottle. Make sure they are dry and clean. After
you have taken your last lot of pills at night, put
the pills for the next day into the bottles. If in the
evening the morning pill bottle is full, you know
that you forgot to take your pills!
Use an alarm
Set the alarm on your watch or your cell-phone to
go off at the time you need to take your pills.
After each dose, set the alarm to ring again at
the time for the next dose.
8
Take your pills with your daily activities
Match your pill-taking time to a daily activity, such as
brushing your teeth, or watching your favourite TV
show. Take one dose at
that time every day. Be
careful to remember at
weekends or when you
go away from home.
Use a calendar
Make a calendar that
shows each day and
the times you need to
take your medicines.
Tick the calendar each
time you take your
medicine.
Support from others
Find a ‘pill friend’, someone who sees you every day
or who will SMS you every day to remind you to take
your medicines. This could be a family member, a
friend, or someone you see at work everyday. Don’t
choose a pill friend who lives far away. The pill friend
can come with you when you first get the ARVs, to
learn about when you must take them.
Never run out of pills
Make sure you get more pills at least a week before
your pills are finished. That way you will never run
out. Running out and missing a few doses in a row
gives HIV a good chance to learn to resist the
medicines.
Talk to your healthworker
If you often forget to take your pills at the right time,
talk to your nurse or doctor about the problem. They
may be able to give you more ideas of ways to take
your medicines regularly.
A mak
hambi ok
ulw
a nengcu
laza A nti-retrov
ir
al treat
men
t
makhambi
oku
lwa
nengculaza
ti-retrovir
iral
treatmen
ment
For the past eight weeks, this series
has told you about antiretroviral
medicines (ARVs), which can stop
people with HIV from getting sick
with AIDS.
We told you about:
‰ the four stages of HIV infection
‰ how ARV medicines change the
viral load and the CD4 count in
the blood
‰ the different groups of ARV
medicines (Regimens 1 and 2)
‰ side effects (when the
medicines make you feel sick)
‰ when to start taking ARVs
‰ why ARVs sometimes don’t
work (drug resistance)
Testing positive for HIV no longer needs to feel like
9
a death sentence. ARVs can give a person with HIV
many more years of healthy living.
ARVs give us a good reason to be tested for HIV.
AIDS can be treated. But to get treatment with
ARVs, you must know your HIV status.
Important things to
know about ARVs
‰ tips to help you take ARVs
correctly
This is the end of the series on
ARVs. If you want to get the whole
series from us (in Zulu or in English)
call (033) 260 5071, or e-mail
[email protected]
Taking ARVs is a lifetime commitment. Once you start
taking them, you should never stop.
Not all people with HIV need ARVs immediately. It is not
good to start taking ARVs too soon.
Start taking ARVs when:
The information in this series is
adapted from Living Positively with
HIV and AIDS: A Wellness Course
developed by Dr Liz Tomson
9
9
your CD4 Count is lower than 200
9
you feel ready to take ARV medicines forever
you show signs of having AIDS (always sick with many
illnesses that don’t get better)
Where to get help
z Clinics test for HIV, and
can do a CD4 count to find
out whether you need ARVs.
They can refer you to a clinic
or hospital that offers ARVs.
z Edendale Wellness and
Care Centre offers courses
and support that help you to
stay healthy. They have the
contact details of all the
community support groups.
(033) 3954336
z Lifeline offers counselling,
HIV tests and information
about resources for people
living with HIV/AIDS
(033) 342 4447
ARV drugs must be taken
every day at the right time.
Miss only a few doses and
clever HIV learns to fight
these medicines.
People on ARVs should take
You need to visit the same
three different medicines
health worker regularly,
together. This is HAART
to keep track of your
(Highly Active Anti-retroviral
treatment. When taking
Therapy, or “triple therapy”)
ARVs you need regular
and it gives you the best
blood tests and check ups.
chance of successful treatment.