It's normal to feel overwhelmed and shocked when you find out you have HIV. But you're not alone. Today, medical science has advanced a lot. HIV is a condition that can be controlled and you can live a healthy, long life. The most powerful weapon we have for this is ART treatment. So today, let's talk very simply about what this ART treatment is, what it does, and how it works so that you understand it.
What is ART treatment in simple terms?
ART is an acronym for Antiretroviral Therapy . Simply put, it is a combination of drugs given to treat HIV infection. HIV is a virus that attacks our body's immune system. Specifically, the CD4 cells (also called helper T-cells), which act like 'soldiers' in our body, destroy this virus. When these CD4 cells are lost, our body's defense system collapses. Then, the chances of developing serious diseases and infections that would not normally occur are much higher.
The important thing is that ART cannot completely cure HIV, but it can greatly reduce the amount of HIV virus (viral load) in your body.
When the viral load decreases, your body is able to make more CD4 cells again. This strengthens your immune system and protects you from serious infections.
ART usually involves a combination of two to four drugs. Giving several drugs that work in different ways is more effective than giving just one drug. It also reduces the risk of the virus developing resistance to the drugs.
Why is this called 'Antiretroviral'?
HIV belongs to a group of viruses called Retroviruses . Normally, RNA (message copies) is made from the DNA (our genetic information) in our cells. But this Retrovirus does the opposite. That is, it uses the RNA it contains to make DNA inside our cells. That is why these drugs are called 'Antiretroviral' because they work against that process. You may hear them called ART, cART (combined ART) or HAART (highly active ART). These are all words that mean the same thing.
What does it mean to have an 'undetectable' viral load?
This is the most important and rewarding aspect of ART. When you take your medication correctly, the amount of HIV virus (viral load) in your blood decreases so much that it is undetectable by routine tests. This is called an 'undetectable' level. This is usually defined as a level of less than 20 copies of the virus per milliliter of blood (< 20 copies/mL).
'Undetectable' doesn't mean you're cured. If you stop taking your medication, the virus that's hidden in your body can become active again. Also, if you take an HIV test, it will still show as 'positive' because those tests look for antibodies against the virus, not the virus itself.
But remember this: Undetectable = Untransmittable (U=U) . This means that if your viral load remains at an undetectable level, you cannot pass HIV on to another person through sexual intercourse. This is scientifically proven today. Also, someone at this level can live a normal, long life, just like someone without HIV.
How does ART work? The story of the HIV virus
To understand how this medicine works, we first need to understand how the HIV virus enters our cells and makes copies of itself.
Think of the HIV virus as a thief. Your CD4 cell is a house. This thief enters the house, uses the same equipment in the house, makes many more copies of itself, and jumps to other houses. In the process, that original house (the CD4 cell) is destroyed.
There are several steps to this process. ART medications work by stopping one or more of these steps.
| Steps | The process that takes place (in simple terms) |
|---|---|
| 1. Attachment | The virus uses one of its proteins (GP120) to attach to a 'keyhole' (receptor) on the surface of our CD4 cells. |
| 2. Fusion | The outer shell of the virus fuses with the shell of the CD4 cell. |
| 3. Entry | The virus's 'toolbox' (Capsid) - that is, its genetic information (RNA) and the enzymes needed to make copies - enters the cell. |
| 4. Reverse Transcription | Using an enzyme (reverse transcriptase) brought by the virus, DNA is made from the virus's RNA. It's like translating an alien language into our own. |
| 5. Integration | The newly formed viral DNA enters the nucleus of our cell and joins our own DNA. This is helped by another enzyme called 'Integrase'. Now our cell thinks that this is also a part of itself. |
| 6. Transcription & Translation | Our cells, just like their own DNA, make copies of this viral DNA, and then begin to make viral proteins based on those messages. |
| 7. Assembly | Another enzyme called 'Protease' comes along, cuts up these formed protein fragments, and assembles them into new viral copies. |
| 8. Budding & Cell Death | The newly formed viruses destroy the CD4 cell, escape, and attack other healthy CD4 cells. |
ART drugs work by interfering with one of the steps mentioned above. Some drugs stop the virus from entering the cell. Others stop it from making DNA. Still others stop it from assembling new viruses.
What medications are used in ART treatment?
ART medications can be divided into several main groups. Each group works by targeting a different part of the HIV virus's life cycle.
- Entry Inhibitors: These prevent the virus from entering the CD4 cell.
- Capsid Inhibitors: Prevent the virus's 'toolbox' (Capsid) from opening or reassembling.
- Nucleoside Reverse Transcriptase Inhibitors (NRTIs): When the virus makes DNA, it provides 'fake' bricks that look like the 'bricks' it needs. When these are used, the DNA chain cannot be completed.
- Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): These go directly to and inactivate the enzyme that makes DNA (Reverse Transcriptase).
- Integrase Inhibitors (INSTIs): Inhibit the enzyme (integrase) that joins viral DNA to our cell's DNA.
- Protease Inhibitors (PIs): Stop the protein-cutting enzyme (protease) from assembling new viruses.
- Pharmacokinetic Enhancers (Boosters): These do not directly affect the virus, but help other ART drugs stay in the body longer and at higher concentrations.
The medication you are given is often a combination of several of these classes. For example, it may be a single pill made up of two NRTIs and an integrase inhibitor.
How do I choose the right ART medication for me?
The doctor treating you will determine the most appropriate medication combination for you after considering several factors.
- Your viral load and CD4 count: It is important to know what these values are when starting treatment.
- Drug resistance of the virus: Sometimes the virus becomes resistant to certain drugs. A test can be done to find out.
- If you have any other medical conditions, such as kidney disease, liver disease, heart disease, diabetes, or high cholesterol, you should tell your doctor about them.
- Other medications you are taking: If you are taking medication for any other condition, there may be interactions between those medications and ART medications.
- Pregnancy: If you are pregnant or planning to become pregnant, there are safe medications that are suitable for you.
- Ease of taking the medication: Consider whether it is a once-a-day pill or two-a-day pill, whether it should be taken with or without food, and how it fits into your lifestyle.
What are the benefits and risks of ART treatment?
Advantages
- Strengthening the immune system: The number of CD4 cells increases, increasing your body's ability to resist disease.
- Protection from serious infections: HIV can protect against opportunistic infections such as pneumonia and tuberculosis.
- Reduced risk of cancer: The risk of developing HIV-related cancers (e.g. Kaposi sarcoma, non-Hodgkin lymphoma) is reduced.
- Preventing AIDS: If left untreated, HIV infection can progress to the final stage called AIDS (Acquired Immunodeficiency Syndrome). ART stops this.
- Preventing transmission to others: As mentioned earlier (U=U) , if your viral load is undetectable, you will not be able to transmit it to others through sexual intercourse.
- Healthy, long life: A person who takes medication properly can live a normal lifespan, just like someone without HIV.
Risks and side effects
Some people may experience side effects when they first start ART. However, these are usually temporary and go away after a few weeks as the body adjusts to the medication.
- Nausea, vomiting
- Stomach upset, diarrhea
- Headache
- Dizziness
- Tired, tired
- Insomnia
- Skin rash
If you experience any of these symptoms, do not stop taking your medication and tell your doctor. He or she can help you find a solution or, if necessary, switch you to a different medication that is more suitable for you. Some medications can have long-term side effects, such as increasing your cholesterol levels. That's why your doctor will check you regularly.
How do you monitor the success of treatment?
After you start ART, your doctor will check you on a specific schedule. He will do two main tests.
| Test | Expected result | Number of times |
|---|---|---|
| Viral Load | This value has decreased to the 'undetectable' level. | Frequently in the first few months after starting, then every 3-6 months. |
| CD4 cell count (CD4 Count) | This value increases . (Healthy level is between 500-1500) | Initially every 3-6 months, then as needed. |
Don't miss a single day of taking your medicine!
The biggest challenge to the success of ART treatment is to take your medication every day, at the right time, without missing a single day . If you miss a dose, the virus has a chance to multiply inside your body again. If that happens, the virus can become resistant to the medication you are taking (drug resistance). Then the medication will stop working and you will have to switch to other treatments. Therefore, it is important to take your medication on time, whether by setting a reminder on your phone or asking a family member to remind you.
Take-Home Message
- ART is a life-saving treatment that controls HIV infection. While it cannot cure HIV, it can help you live a healthy, long life.
- It is essential to take your medication every day, on time. If you miss your dose, the virus can become resistant to the medication.
- If the amount of virus in your blood is 'undetectable', you cannot pass HIV to another person through sexual intercourse (U=U).
- Side effects may occur early in treatment, but they are usually temporary. Talk to your doctor about any discomfort.
- HIV is just another chronic disease. With the right treatment and management, you can live a full, happy life. You are not alone.
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