The drugs that suppress or control HIV are called anti-retrovirals or ARVs for short. Three ARVs are taken together as anti-retroviral Treatment (ART). ARVs work by stopping HIV from hijacking the body's CD4 cells to make more copies of the virus. This is why when ARVs are taken properly, the viral load goes down, which means there is less HIV in the blood and body. And, at the same time, the CD4 count goes up and the immune system recovers and becomes strong again.
There are many different kinds of ARVs. To suppress HIV properly and stop it from multiplying, three different ARVs must be taken together. Sometimes the three ARV drugs used to suppress HIV are combined into one pill that is taken once a day, this is called a Fixed-Dose Combination (FDC). The three ARV drugs can also be taken as two or three separate pills, taken once or twice a day.
Because young people with HIV are still growing, the dosing of HIV medicines is not always based on their age, but usually on their weight or stage of development. The doctor or nurse will prescribe ARVs according to the weight and stage of development of a young person. Everyone, including young people should start ART as soon as possible and not wait to be sick or have symptoms. South Africa has a Test and Treat Policy, which means that if a person tests positive for HIV they can start taking ART immediately, no matter what their CD4 count is. Talk to your healthcare worker to find out what treatment regimen the young person in your care will be on. ARV treatment is for life and not taking the treatment correctly can cause serious health problems such as drug resistance, which makes HIV immune to the ARVs given and more difficult to treat in the long run. Therefore it is important that you encourage the young people in your care to take their ARVs as prescribed.
For more information on Anti-retroviral treatment (ART) get a copy of the Zenzele Living with HIV:Making treatment work brochure available in our Downloads section.
Adhering to Treatment
There are many benefits to taking ARVs. Once you start taking your ARVs it is important to always take them exactly as prescribed by your healthcare worker. This is called adherence. Adherence to ART leads to viral suppression. Viral suppression is when the amount of virus in the blood has dropped so much - to less than 50 copies of HIV per millilitre of blood - that it cannot be detected by a viral load test. This does not mean that HIV is cured, it means that there is only a small amount of HIV in the blood.
Viral load suppression has many benefits:
- HIV will not harm your body, which means you can live a healthy life
- There is less risk of developing drug resistance and having to switch to a second-line of HIV treatment, which has more side effects
- There are less chances of passing the virus onto a sexual partner
- You can have HIV-negative children without passing the virus onto your partner when you follow the PMTCT program
Young people may have difficulty in adhering to their treatment due to factors such as:
- The unpleasant taste of some of the medicines;
- A complicated HIV regimen that includes many pills, if this is the case, please speak to your Healthcare worker about alternative ART regimens;
- A busy schedule that makes it hard to take HIV medicines on time every day;
- Mental health problems or alcohol or drug abuse;
- The fear of stigma and being seen taking ARVs
You can encourage the young people in your care to adhere to their ARV treatment by:
- Helping them to identify their life goals and reasons to stay healthy;
- Helping them to identify a support system to help them through the treatment;
- Explaining the treatment process and how often they will have to go back to the clinic for testing and to collect their pills;
- Explaining what will happen if they do not follow the treatment plan;
- Explaining that the ARVs may have some side effects and talk to them about how they can cope with these;
- Talking to them about the impact of alcohol or drug abuse on taking treatment;
- Making reminders for them to take their pills at a specific time every day;
- Helping them find a good place for them to store their pills;
- Planning with them what to do in case of an emergency related to their treatment;
- Motivating them and offering support when taking treatment might seem difficult for them.
Treating opportunistic infections
Opportunistic infections are infections that occur more frequently and more seriously in people who have a weakened immune system. Many young people living with HIV develop these infections because they may not know about their HIV infection, they may not be on treatment yet or may not be taking their treatment correctly. Because of this their viral load is too high for their immune system to fight off infections.
Common infections include fungal infections such as thrush or pneumocystis pneumonia (PCP); parasitic infections that cause diarrhea or lung disease; viral infections such as herpes, human papillomavirus (HPV), meningitis and other bacterial infections like Tuberculosis (TB), which is the most common co-infection for people living with HIV in South Africa.
It is important for young people living with HIV to be familiar with the causes of opportunistic infections and how to prevent them. It is also important for them to know the symptoms of common opportunistic infections so that they can report these to a healthcare provider for early diagnosis and treatment. With the correct and early treatment, most of these opportunistic infections can be cured successfully.