What is antiretroviral therapy (ART)?
Medicines used in the management of HIV/AIDS are known as antiretroviral therapy (ART). It is recommended for everyone who has HIV. The medicines do not cure HIV infection, but they do make it a manageable chronic condition. They also reduce the risk of spreading the virus to others.
The breakthrough in HIV treatment came when researchers discovered that a failed cancer drug from the 1960s, zidovudine, stopped HIV from multiplying and helped people with AIDS live longer. Also called azidothymidine (AZT), the medication became available in 1987. The FDA approved AZT in less than 4 months, fast-tracking a process that usually takes many years. It treats HIV, but it isn’t a cure.
How do HIV/AIDS medicines work?
HIV/AIDS medicines reduce the amount of HIV (viral load) in your body, which helps by
- Giving your immune system a chance to recover. Even though there is still some HIV in your body, your immune system should be strong enough to fight off infections and certain HIV-related cancers.
- Reducing the risk that you will spread HIV to others.
What are the types of HIV/AIDS medicines?
There are several types of HIV/AIDS medicines. Some work by blocking or changing enzymes that HIV needs to make copies of itself. This prevents HIV from copying itself, which reduces the amount of HIV in the body. Several medicines do this:
- Nucleoside reverse transcriptase inhibitors (NRTIs) block an enzyme called reverse transcriptase
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) bind to and later change reverse transcriptase
- Integrase inhibitors block an enzyme called integrase
- Protease inhibitors (PIs) block an enzyme called protease
Some HIV/AIDS medicines interfere with HIV’s ability to infect CD4 immune system cells:
- Fusion inhibitors block HIV from entering the cells
- CCR5 antagonists and post-attachment inhibitors block different molecules on the CD4 cells. To infect a cell, HIV has to bind to two types of molecules on the cell’s surface. Blocking either of these molecules prevents HIV from entering the cells.
- Attachment inhibitors bind to a specific protein on the outer surface of HIV. This prevents HIV from entering the cell.
In some cases, people take more than one medicine:
- Pharmacokinetic enhancers boost the effectiveness of certain HIV/AIDS medicines. A pharmacokinetic enhancer slows the breakdown of the other medicine. This allows that medicine to stay in the body longer at a higher concentration.
- Multidrug combinations include a combination of two or more different HIV/AIDS medicines.
How should I take my antiretroviral treatment?
When and how you take your ART will vary depending on the specific antiretroviral drugs you take. Most antiretroviral drugs are taken once a day, with or without food. However, some drugs are taken twice a day. If this might be something you find difficult, talk to your doctor about your options.
Once you start ART it’s very important that you take it properly and don’t miss or skip doses, as this can lead to something called HIV drug resistance, and may mean that your drugs don’t work as well for you in the future. If you’re finding it hard to take your treatment at the right times and in the right way, speak to your healthcare worker. They can offer you support and give you advice on how to make taking your treatment easier.
Does antiretroviral treatment have side-effects?
As with all medication, starting to take ARVs can cause some side-effects, particularly in the first few days of treatment. This is another topic you could discuss with your doctor, as it might also affect your choice of drugs. Your treatment will be monitored and you may be recommended to switch drugs if they aren’t working for you or if you’re finding the side effects difficult to manage.
Do HIV meds cause diabetes
Yes, some HIV medicines can increase the risk of type 2 diabetes in people with HIV. Generally, people with HIV are more likely to have type 2 diabetes than people without HIV, this is because most of them posses the risk factors for diabetes.
In addition, chronic inflammation (ongoing activation of the immune system) in response to HIV infection may also raise the risk of diabetes. This dysfunctional response of the immune system can harm organs and body systems. HIV treatment and a healthy lifestyle help reduce inflammation but can’t completely eliminate it.
Which HIV Meds Cause Diabetes?
The list of anti-HIV medications that contribute to diabetes risk include;
- Older nucleoside reverse transcriptase inhibitors (zidovudine, stavudine and didanosine)
- Older protease inhibitors (indinavir and lopinavir).
These drugs are not generally used today but you may have taken them in the past.
Some newer treatments that can increase diabetes risk include:
- Dolutegravir and Bictegravir
- Raltegravir and Elvitegravir
These HIV medications have been associated with weight gain, although the reasons for this remain unclear. It’s generally the case that weight gain increases the risk of developing diabetes, but it is not yet clear if the weight gain linked with integrase inhibitors does so.
Overall, integrase inhibitors are well tolerated with few side effects for most people and they may help you suppress your viral load more quickly than other HIV medication. You can still reduce your risk of diabetes by making healthy changes to your lifestyle, including diet and exercise. If you do feel you are gaining excessive weight on your HIV medicines, you should discuss this with your HIV clinician.
Taking antiretroviral treatment with other medicines
If you are taking other medications or drugs including: treatments for other health conditions; contraception (family planning); hormonal therapies; or use psychoactive drugs, it’s important that your doctor knows about this. Different drugs can interact, changing the way that they work. This may mean that a drug becomes too strong (which can be dangerous) or that a drug becomes too weak, so that it can no longer control your HIV, prevent pregnancy or treat another health condition. Discuss the medication you take with your healthcare workers so they make sure that the combination is safe and will work well for you.
What else do I need to know about taking HIV/AIDS medicines?
It’s important to take your medicines every day, according to the instructions from your health care provider. If you miss doses or don’t follow a regular schedule, your treatment may not work, and the HIV virus may become resistant to the medicines.
HIV medicines can cause side effects. Most of these side effects are manageable, but a few can be serious. Tell your health care provider about any side effects that you are having. Don’t stop taking your medicine without first talking to your provider. He or she may give you tips on how to deal with the side effects. In some cases, your provider may decide to change your medicines.