HIV more susceptible to Opportunistic Infection

Opportunistic infections

As the immune system becomes increasingly damaged by HIV it is more susceptible to opportunistic infections. These infections would usually be fought off by a healthy immune system, but a low CD4 cell count means opportunistic infections such as PCP (a type of pneumonia) can be life-threatening. If one of these illnesses becomes a serious problem, antiretroviral treatment may be advised immediately.

Making a decision

Treatment should only be started once the person is ready. A lot of commitment is needed, since following a drug regime can be quite demanding and in most circumstances, the treatment will have to be taken for life.

Once it is decided that treatment should be started, doctors will advise of the various HIV drugs and combinations available and which might be most suitable.

Choosing the best combination

In the developed world, there are a number of drug combinations available to choose from. There are more than 20 approved drugs belonging to five groups. It is not always easy to tell which will be the best option, since a combination that suits one person might not suit another.

The first combination of drugs that a person is given is called first line therapy. For treatment in resource-poor countries, the World Health Organisation recommends a first line regimen of one NNRTI and two NRTIs, such as AZT or tenofovir combined with 3TC or FTC. American guidelines recommend one NNRTI or a PI combined with two NRTIs.

The effectiveness of the drugs depends heavily upon taking them exactly as prescribed. Therefore when choosing a combination, it is important to think about how the drugs may affect lifestyle. The combination must be right the first time, as antiretrovirals are most effective in people who have not had any treatment before.

The following issues need to be considered before starting treatment:

The effectiveness of the combination

Some combinations of antiretrovirals are more effective than others. Taking drugs randomly from the different ARV groups may result in a weak combination that doesn’t suppress the HIV infection sufficiently, ending in drug resistance. A few drugs have harmful effects when used together and should not be combined (an example is stavudine and zidovudine).