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Sexual health and LGBT population
Living with HIV
Post-exposure prophylaxis (PEP)
Medications used to manage HIV are called antiretrovirals (ARV is a common abbreviation).
Antiretrovirals function in a fashion similar to antibiotics – while antibiotics attack bacteria and antiretrovirals attack viral invaders (in the case of HIV – a retroviral infection). It is not quite accurate to say that ARV medications actually attack HIV – in fact they target different paths along the reproduction cycle of HIV and thereby prevent HIV from multiplying or reproducing.
The HIV virus has a very short lifespan in the human body. As mentioned earlier, the virus has as its main objective its survival and reproduction of new infectious virus (make new copies of HIV). The role of ARVs is to prevent replication. When this is achieved with medications the virus dies without making copies of itself. It is in this manner that medications allow you to decrease the amount of HIV in your blood and body – ultimately resulting in a decreased viral load. Once again, the logical process is simple: we prevent the virus from reproducing and the virus dies off decreasing the amount of virus present thereby slowing down the destruction of the immune system and ultimately permitting your body to rebuild your immune system.
Lower your viral load: maintaining suppression of the virus permits low viral activity and fewer CD4 cells are infected. Ideally, in the weeks to months subsequent to the start of medications your viral load should decrease to below the level of detection. (Undetectable viral load: please refer to the section What is the viral load?).
Stop the decline/loss of CD4 cells: given that the majority of AIDS related infection and complications (opportunistic infections) occur when CD4 cell counts fall below 200, it is critical to attempt to avoid the decline towards this precarious level. Prevention of CD4 cell progression below 200 is essential in the prevention of the progression to full blown AIDS.
Ideally, one of the objectives of treatment of HIV is to ultimately increase the number of CD4 cells and reinforce your immune system. This is particularly important if your therapy was started when you were already at a low level of CD4 cells. Treatments often (sometimes quickly, sometimes slowly and every time frame in between) permit the reassuring rise in CD4 cells. The goal is to reach levels above the “danger zone” of 200. Of note: one should not be obsessed with the number…while your CD4 cell counts may not be rising dramatically – if you are in the safe zone (above 200 and are doing well and feeling well…that is the most important result!). Your clinical or overall health status is more important than the absolute numbers – if you are troubled by your results - speak with your doctor.
The combination of your viral load tests and CD4 cell counts are very helpful in evaluating your response to medications. Feeling well and maintaining control with an undetectable viral load and rising CD4 cells are the sign of a successful antiretroviral therapy…You are in charge!!
Unfortunately, there is no current medication or combination of medications that enable us to cure or completely eliminate HIV from the body (please refer to the section Why are treatments unable to completely erradicate HIV from the body?). Nonetheless, combination therapies of ARVs have greatly improved the lifespan and quality of life of individuals living with HIV. Since the advent of the first "triple therapies" in the late 1990s, there has been a significant decrease in the rate of infections, their complications and death secondary to HIV/AIDS (greater than 80% reduction).