Living with HIV
Diagnosis: HIV positive:
You have just found out that you are infected with HIV? Maybe you decided to buy a rapid HIV test and it was positive or you already have the doctor’s confirmation. A positive HIV home test should definitely be confirmed by a doctor. Probably you will want to know now how it goes on and what opportunities you have. Reading this page is a good start on your lifelong path to learning how to handle HIV.
You are OK…
First of all, you are OK. This is not the end of your life and you will not die soon. You do not have to tell absolutely anyone that you’re HIV positive, especially not if you’ve got the result of a rapid HIV test. And most importantly, you do not have to pretend that everything is the same as always. Because nothing is more now than ever. Remember: your life is not over now. You have all the time in the world to learn to deal with this new situation.
It is perfectly normal for you to “roller coaster” emotionally as you learn to accept the idea that you will live with HIV in the future.
Diagnosing HIV changes you and your life forever. It is perfectly normal for you to have many and also contradictory feelings as you learn to accept the facts.
How are you now, right now? Maybe you are very calm, or totally panicked, or maybe everything was fine until that moment when someone made a careless remark. Maybe you compensated by partying a little too often and drinking a little too much. Or you’ve sneaked into your shell – but now you feel that you can not go on forever.
However you are, it is very important that you always tell yourself that it is okay and that you allow what you feel. It helps if you let it out – be angry, be sad, be cool, be quiet, be scared or feel nothing. When your feelings beat over you, try to be careful not to hurt yourself or others. Think about whether you do not want to accept help. For example, from counselors, other people living with HIV, friends and family. Talking about your feelings is very helpful.
You have a future
People with HIV now live a long and fulfilling life.
Maybe right now, it’s hard for you to believe that. But HIV is not a death sentence. There is tremendous progress in the treatment and care of HIV. People with HIV infection now live a long and fulfilling life. There are even medical professionals who believe that people with HIV can retain their natural lifespan through treatment.
Since it looks like you’re here for a while, you’re going to have a future. You can still have sex, or a deep relationship, a family and a career. Perhaps you are just thinking that there is no point in pursuing any of your goals that you had before the diagnosis. Tell yourself that it is OK to be discouraged now, but also that there is no reason to give up any of your goals and dreams. If you feel sad and hopeless, no fun, and those feelings just do not go away, then you should talk to your doctor about it. You may be in depression. For some, that is part of it, and there are supportive therapies that will help you out again.
There are several groups and organizations, most of them called AIDS relief organizations that help people with HIV.
Will there be many new challenges in the future? However – in health and social terms alike – but there are groups and people who can help you with that. AIDS support groups are a great way to meet other people living with HIV. And if you still do not feel ready to get in touch with such a group, that’s fine. They will be there for you if you feel able to talk to someone.
The fact that you now have an HIV diagnosis also means that you can now take action to care for you.
Maybe you curse the day you got your diagnosis. It’s very hard to hear something like that. But the fact that you have a clear diagnosis now means that you can do something now. Knowledge is power. It’s easy to say that, but with HIV, that’s a fact. Now that you know about him, you can decide how to live with the virus. You probably will not want to know it all so well in the beginning, but over time you will learn what is important to you and you will find your own way of living with HIV.
How this guide can help you
Your health organization will show you the steps you should know to take care of yourself as you learn to live with HIV.
Your health organization will give you important clues about what you should keep in mind on your way to living with HIV. First of all, it is important to think about which doctor you want to seek treatment for. You may also want to get in touch with groups and organizations that help you learn to live with HIV. Equally important is thinking about what you can do and what you need to do to protect your health and those around you. The next few chapters will give you an overview of the most important questions.
HIV … the basics
First, basic and somewhat complicated areas are explained: how your immune system works and how HIV makes you sick. It’s good to read through these pages to learn more about CD4 cells, seroconversion and other important basics. So it will be easier for you to understand the contents of the other chapters.
What is HIV? What is AIDS?
HIV is a virus that can attack and weaken your immune system. If this progresses far enough, your body will not be able to defend itself against infection, you will get sick. HIV is the abbreviation for “human immunodeficiency virus”. Immunodeficiency means a weakened immune system. People who are infected with the virus are said to be HIV positive (also known as “HIV +”).
HIV weakens your immune system, the part of your body that is actually there to ward off infection. The virus slips around the defense and practically reverses it, weakening you from within. If your immune system is very weakened, you will get sick from many infections. Even a harmless cold can be life-threatening because your body can no longer contain the infection.
What is HIV and AIDS? HIV is the name of the virus, AIDS is the name of the disease that arises when the virus infects the so-called CD4 cells, which are supposed to ward off infections. Instead, they carry on the infection, the body has nothing to oppose. This mechanism makes HIV so dangerous.
AIDS is a shortcut. It stands for “Acquired Immuno Deficency Syndrome”, to German “acquired immune deficiency syndrome”. This means that your immune system is getting weaker and weaker, until it eventually collapses. Your body can no longer defend itself against infections or heal them. AIDS can become AIDS, but does not have to! There are now very effective drugs to stem the spread of HIV. An HIV infection does not necessarily mean that you are also suffering from AIDS. Thanks to the treatment many infected people live for many years without getting sick.
What is a virus?
HIV is a virus that destroys cells of the immune system that ward off infections.
Viruses are the smallest and simplest life forms. They are even smaller than bacteria and other germs. Some scientists are struggling with the term “life form”, because viruses do not show the typical signs of life. For example, they do not plant themselves. Rather, they inject their DNA into healthy cells, ensuring that the cells produce more viruses. These new viruses go into the bloodstream and lymphatics of the afflicted and infect more and more cells. Therefore, one also speaks of the viral load, or the flooding rate.
How is HIV transmitted?
HIV infection occurs when enough HIV viruses enter the body of an HIV negative.
HIV infection occurs when enough HIV viruses enter the body of an HIV negative. This is NOT done by light contact such as shaking hands, sneezing or touching a door handle or the toilet. An infection only occurs when enough of the body fluids with enough viruses get into the body of an HIV negative from an HIV positive.
There are only five body fluids where viral repletion can be high enough for infection. These are blood, semen (also prostate fluid), vaginal secretions, anal secretions and breast milk. Infections can therefore take place during sex, or because you use together syringe, during pregnancy, childbirth and breastfeeding. When HIV became known in the 1980s, it was also possible to infect contaminated blood donations. In the meantime, however, controls in Europe are so stringent that this route of infection is ruled out. Basically, blood-to-blood transmissions are also possible, but this is only relevant if you work in healthcare. In this case, the normal infection protection, ie the use of rubber gloves, is sufficient for effective protection.
It is well known that people who are receiving treatment and taking HIV medications so that the amount of virus that is no longer detectable in their bodies are significantly less likely to infect than untreated patients. Studies show that patients with undetectable virus levels do not transmit HIV through sex. More information below.
There is little to no risk of HIV transmitted through uninjured skin. Much easier, however, is the transmission via the mucous membranes. This refers to the moist and thin skin layers on body openings, such as the vaginal or anal mucosa, as well as in the urethra in men and women. HIV can also penetrate intact mucous membranes and infect cells. If you have another sexually transmitted disease, such as syphilis, gonorrhea or herpes, then the infection is even easier. Even small mucosal injuries, as they can happen during sex, of course, favor infection.
How to become infected with HIV? Sexual activities that can easily lead to infections are also called “high-risk contacts”. High-risk sexual contacts include vaginal and anal sexual intercourse:
– if no condom is used, or
– if there is no effective treatment that suppresses the amount of virus in the patient’s blood to “undetectable” and thus prevents transmission, or
– without taking certain medicines that prevent the transmission of the virus (prophylactic measures)
Some sexual practices, such as oral sex, carry only a low risk of infection. They can lead to infection, but this is not very likely. Other practices pose no risk. These include: kisses, hugs, mutual satisfaction or even massages.
HIV can also be transmitted by sharing hypodermic needles or syringes, such as taking drugs.
It is important for you to be aware of these risks and how to minimize them. What many do not know: You can get infected again after an HIV infection. This is very dangerous because it damages your immune system even further. The HIV virus is changing (“mutated”) very fast, so it is simply wrong to believe that two HIV-positive partners can not catch each other. Some HIV versions are resistant to antivirals. It is precisely these pathogens that can be fatal if you are already HIV-positive.
How do you know if you have HIV?
To be sure, you have to take a blood test.
To find out if you are HIV infected you need to take a blood test. This test is often falsely called the AIDS test. In fact, the test looks for HIV antibodies in your blood. Here the concentration is highest.
How does the HIV rapid test work? Actually quite simple: A drop of blood is taken from you and given to the test strip. After a short time, usually about 1 minute with the INST HIV Self Test, the test reports “positive” or “negative”.
The INSTI HIV Self Test looks for so-called antibodies. These form the answer of your immune system to an infection. Therefore, after a possible infection you have to wait quite a while, at least six weeks to get a really meaningful test. That’s how long it takes at least until your body has developed enough antibodies to make a result clear.
The detailed version of the HIV test is performed by the doctor. Here you will be taken blood from the arm vein and sent to the laboratory. As a result, it can take a few days to two weeks, but more important information can be derived from this test for your treatment. Quick tests are very accurate, but not very meaningful in terms of virus quantity and type. Therefore, a lab test makes sense if the quick test was positive.
The time between infection and the formation of antibodies is also called incubation time. Of course, the body reacts immediately after infection, but it requires a certain concentration of antibodies, so that the common tests can also indicate them safely. You have absolutely safe results after eight to 12 weeks. If the test was negative, it makes sense to retest after six months. Your consultant or doctor will tell you which test method is best for you.
A positive test means that you are infected with HIV. You can transmit the virus if you have unprotected sex or share syringes with others. It does not mean that you have or will get AIDS. He does not make any further statements about your state of health.
That's how your immune system works
Some germs are constantly around us and by the way also in us. Not all of them are harmful, some we even need them. In the gastrointestinal tract, for example, there is an abundance of “friendly” bacteria that we need for proper digestion.
Normally, your immune system protects you from harmful germs by recognizing and destroying them.
However, many germ species can make you sick. From mild discomfort, such as a cold, to deadly diseases, there are many types of infections. Thankfully, your immune system usually protects you by detecting and destroying harmful germs.
The first “line of defense” of your body is the skin. It encloses the body and functions as a physical barrier against germs. If you have skin injuries, even tiny ones, they can be used as an input for viruses and bacteria.
Your mucous membranes are the moist layers in your mouth, nose, genitals and anus. They protect the body at the cellular level from the ingress of germs. This protection is also called mucosal immunity. However, they are not perfect protection. If there are minor injuries, or if the mucous membranes become thinner, they can provide entry points for viruses and germs. Some germs can even pass through the intact mucosa.
Fortunately, the immune system has much more to offer. It consists of chemical substances, cells, tissues and organs. It is built up throughout the body and kept going. The most important “players” are the white blood cells, also called leukocytes. They are constantly present in the whole body and keep watch. Also in the lymphatic system white blood cells are present.
Your cardiovascular system, as the name implies, consists of your heart and blood vessels. In these ways, blood is pumped into all organs and tissues. Your lymphatic system works with lymph, a clear fluid that captures germs and locks them in your lymph nodes. The lymph nodes are located in all body flexions, such as the groin, the armpits or along your lower jaw.
Surely you have ever had swelling of the lymph nodes, if you had a cold. Then the lymph has blocked germs that had infested your upper respiratory tract into the nearest lymph nodes. There, it causes an inflammation, while the body produces, inter alia, histamine, a substance that kills germs. Even so-called feeding or killer cells, also called T cells, are released. These cells have the “locks” to the “keys” on the germs. They dock, swallow the germ, and die off with it. You’ll learn more about that right now.
CD 4+ cells
This cell type plays an important role in the immune system.
Scientifically, this term is wrong. Now we are not scientists, but we still want to explain what is meant correctly, otherwise you would not be able to understand your doctor, who is a scientist.
Among the lymphocytes, the “guard cells” in your immune system, there is an important, because active type: the T cells. This cell type often has “add-ons”, so-called helper proteins that differentiate the task of the cell. When the protein CD4 is at the cell, it is called CD4 positive (CD4 +) and is a so-called helper cell. In the blood of a healthy adult, between 27% and 54% of lymphocytes have T-cells with CD4 +.
These cells “mark” an enemy germ. They do not fight it, but sit on it and “call reinforcement”, thus initiating the actual immune response. You could call them “scouts” who first recognize the need for an immune response. Now you understand why these cells are so important: without them, your body could be infected without your immune system even noticing.
How HIV can make you sick
Unfortunately, the HIV virus attacks and destroys CD4 + cells. This can lead to a massive weakening of the immune system, because it loses as its “eyes and ears”. It also massively reduces the speed of an immune response: the fewer “guardian cells” there are, the further an infection can progress before it is even recognized as such.
If he immune system is weakened enough by HIV infection, any other infection can become very dangerous, even deadly.
Your body defends itself by producing new immune cells at full speed. Over time, however, the virus often wins. Remember, it injects its DNA into the nuclei of your cells, turning them into virus factories. The immune system loses more and more control over the amount of virus and can suppress fewer and fewer infections as well as certain cancer cells. These other infections as well as the no longer suppressed cancer cells can become serious and even deadly diseases.
If you can not be treated with anti-viral drugs after you have been diagnosed with HIV then HIV trains you at different stages of your illness. In some patients, this is very fast, others still live for many years without a life-threatening infection. With effective HIV therapy made possible by modern and highly effective drugs, most patients do not have to go through the disease phases and remain healthy despite being diagnosed as “HIV positive”.
The first stages of HIV infection
Within two to four weeks of the infection, you might experience symptoms similar to those of a flu. You may feel choppy, have a rough neck, notice swelling of your lymph nodes, headaches, loss of appetite, or skin irritation. During this time, the immune system begins to recognize HIV.
Primary infection means when you first became infected with HIV. Most people do not suspect at this time that they are infected. Nevertheless, the virus is already multiplying very fast. Within two to four weeks of the infection, you might experience symptoms similar to those of a flu. You may feel choppy, have a rough neck, notice swelling of your lymph nodes, headaches, loss of appetite, or skin irritation. This malady usually lasts only a few days, but can last up to 10 weeks. Not everybody gets these symptoms, so this is not a reliable sign.
If you have these symptoms after an unprotected sexual contact or using a used syringe, then go immediately to the doctor and get tested for HIV. Alternatively, you can first do a home test. The surely anxious question “How do I know if the test was carried out correctly?” Answers the detailed leaflet. This path is uncomfortable, but research shows that the sooner a diagnosis is clear and treatment begins, the greater the likelihood that you will stay healthy.
During this phase of so-called seroconversion (change in blood composition), your immune system learns to recognize HIV. It has not yet begun to produce antibodies that could stem the virus. That means:
– The amount of virus in your blood is likely to be very high
– Your CD4 + value may decrease until your body responds to the virus
– Standard HIV tests are probably still “negative” even though you are infected because they are looking for antibodies that you do not have at this point
– You can infect others already and most likely you will be left without precautions, because there are large amounts of virus in your blood. Therefore, the likelihood of infection after a fresh infection is particularly high.
If your body then makes antibodies to HIV, it’s called seroconversion. These changes in your blood composition are usually completed after one to three months. The HIV test, which usually looks for antibodies, will only “positive” after conversion of your blood composition. Unfortunately, if your test is negative shortly after a high-risk contact, that does not necessarily mean “all-clear.”
After one to three months, when the seroconversion is completed, your virus count will again be noticeable, compared to the high value observed during the first phase of the disease.
The next stages of HIV infection
If not treated, the virus copies itself very quickly and infects other CD4 + cells. Your body tries to balance the loss of cells by producing new, healthy cells. In most cases, the virus eventually overruns your immune system.
In the next phase of HIV infection, you may feel completely fit for a long time, even if you are undiagnosed and untreated. Even if your immune system can not cure the infection, it can do very well. You could say the virus and you, you have arranged in a kind of stalemate. Your CD4 + cell rate and the number of viruses remain relatively stable during this time, the virus rate can increase slightly, if you have to deal with other infections such as a cold. Many people have no symptoms of HIV infection during this time. Therefore, this phase is also called the asymptomatic infection.
This is the longest stage of HIV. In many patients, this phase lasts for 10 years or longer, but there are also patients in whom this stage is significantly shorter. During the asymptomatic infection phase, the virus copies itself very quickly and infects other CD4 + cells. Your body is trying to make up for the loss of these cells by producing new, healthy cells. As long as your body can replace the infected cells with new ones, your immune system stays strong. But if you are not treated, the virus will eventually win the fight.
The power of your immune system is measured by the number of CD4 + cells. You will learn more about this later when it comes to monitoring your health.
Without anti-HIV treatment, sooner or later the virus will overrun your immune system. This means that your CD4 + value starts to fall and you sooner or later run the risk of developing symptoms of HIV infection. It may, for example, swelling of the lymph nodes occur, night sweats, diarrhea, weight loss, fatigue and fever. You can get diseases like thrush (oral rot) or persistent vaginal yeast infections. These are all signs that the HIV infection is progressing. See below for more on diseases related to untreated HIV infection.
So an untreated HIV infection usually progresses.
If your HIV infection is not treated, you may come to the stage commonly called AIDS. Experts have compiled a list of diseases that define AIDS and that are used to diagnose and diagnose AIDS. These diseases only include serious and life-threatening infections. These include bacterial infections such as the mycobacterium avium complex. This group of bacteria affects almost exclusively people with weakened immune systems and is therefore considered as an indicator of AIDS. It causes diseases of the lungs, which are similar to tuberculosis, but also causes painful joint inflammation and kidney inflammation. The typical infections include fungal infections as well as Pneumocystis pneumonioa, it causes pneumonia. AIDS-typical diseases are also cancers such as non-Hodgkin’s lymphoma (a form of lymphoma cancer) or Kaposi’s sarcoma (a form of bone cancer).
In the meantime, people often talk about HIV or chronic HIV infection, because, fortunately, AIDS is now rarely the result of HIV infection.
Before there were effective drugs to stem the HIV virus, it was almost imperative for most HIV patients to eventually develop AIDS and die from it. However, since there are now effective drugs, HIV infection does not necessarily lead to a life-threatening disease. Anti-HIV medicines can disrupt the progression to AIDS and help patients recover from AIDS-related illnesses to recover and stay healthy.
The way we talk about HIV and AIDS shows this new reality. In the meantime, people often talk about HIV or chronic HIV infection, because fortunately, AIDS is no longer necessarily the result of HIV infection.
The importance of chronic inflammation in HIV disease
Anti-HIV drugs are highly effective at reducing the amount of virus in your body. However, they can only control but not cure chronic inflammation caused by the infection. Inflammation starts in the early stages of HIV infection and continues over time. They are part of the body’s immune response to injury, infection or irritation. This reaction always happens when we get hurt, come in contact with something we are allergic to, or get infected with an infection. Then immune cells are activated and go to the place of the action. The consequences may be redness, swelling, heat, pain or dysfunction in the affected area.
Inflammation is one of the healing mechanisms in our body. This is very helpful in acute infections and usually works well. But if the inflammation persists for a long time, it will turn into the opposite. It can then even promote the development of diseases. If not intervened, it can have very unpleasant consequences: The inflammation can damage immune cells, destroy tissue, damage organs and the nervous system, and cause other diseases.
Scientists are researching the importance of inflammation for the health of HIV patients. In particular, long-term consequences are being researched in the fields of heart disease, liver diseases and kidney damage as well as other organic diseases, such as osteoporosis.
Guide to HIV treatment
Simply put, HIV treatment is life-saving. There is no cure for HIV, but with the now-proven drugs, you can keep the virus under control for a long time. The patients stay healthy, many even throughout their lives.
Left untreated, HIV weakens the body, especially its ability to fight off certain cancers and infections. But when HIV medications are taken daily, patients can protect their immune system and ward off infection. With the right treatment and therapy, they stay healthy and can lead a long, fulfilling life.
It is also well-known that taking HIV medication and achieving and maintaining a non-detectable amount of virus is treated as a very good way to minimize the risk of contracting others.
Maybe you just got the HIV diagnosis and start your treatment. Maybe you have been in treatment for some time and would like to get further information. No matter what, this guide is for you! We also hope that it will be useful for relatives, life partners, friends, physicians, pharmacists, nurses, counselors, and anyone who accompanies and supports HIV patients on their journey.
This is how the right treatment is found for you
What if the HIV test is positive? We have already seen that this situation is serious, but not directly perilous. Further blood tests in the laboratory will determine what type of HIV is in you. There are so many different things that you need to talk about a virus group. Once the virus has been identified, the first indications are as to which drugs can be used most effectively to control it. So you do not need to worry about testing many meds and having to go through many side effects before your combination is found.
The ideal combination is the one that:
– effectively suppresses the virus and pushes your viral load to “undetectable” and stops there,
– improves the CD4 values,
– produces the least possible side effects
– is easy to take.
Depending on how healthy you are and under what circumstances you live, some preparations are more or less well suited. Below we will look at how to find the right combination for you.
Different groups of active ingredients
Two common drugs used in combination therapy are called NRTIs (Nucleoside Analogs / Nucleotide Analog Reverse Transcriptase Inhibitors). Because these drugs need to be taken at the same time, different pharmaceutical manufacturers have developed combined preparations so you only need to take one tablet containing all the active ingredients. Mostly, a third drug is involved to attack HIV from multiple directions. Known and common active substances from this class are, for example:
The medicines containing these active ingredients are available under different trade names. If you want to find out about the effects and side effects of the Internet, it is best to search for the name of the active substance itself.
Integrase inhibitors (II) form another group of active ingredients in antiretroviral agents. They have several advantages: when used as part of combination therapy, they very quickly suppress the viral load in the blood. They usually produce only minor side effects and have little interaction with other drugs. Interactions are unwanted effects that can arise when two drugs are taken at the same time.
When resorting to protease inhibitor (PI) -based therapies, the patient usually has to take more tablets than others. They should be taken for food. However, they have a key advantage: if the virus in you does not respond to a PI, it is still vulnerable to another PI preparation.
Usually a small amount of another drug is given here, which acts as a booster. These are usually drugs such as ritonavir or cobicistat. The booster enhances the effect of the PIs, so you only need to take medication once a day. However, the booster interacts with stimulants such as Extasy, Crystal Meth, Cocaine, Benzoediazepine or with erectile dysfunction drugs such as Viagra.
Non-nucleoside reverse transcriptase inhibitors (NNRT) are another group of drugs. Against these agents, the virus seems to be insensitive faster than against other species. Attention! Some of these supplements can lead to false positive drug screenings. So, if you get such a drug and drive a car, you should have the medicine pack with you if you get into a drug check.
The so-called EIs (Entry Inhibitors) are rarely used. Most of all, they receive patients whose viruses have developed resistance (insensitivity) to most other drugs. Most of these preparations must be taken twice a day and as an injection. In Germany, the active ingredients Enfuviritide and Maraviroc are on the market here.
Another word not commonly used in Germany for entry inhibitors are the so-called CCR-5 (C-C motif chemokine receptor 5) inhibitors. CCR-5 describes a gene mutation that prevents viruses from docking to a cell. Of course, that is only very simplified. This altered gene was found in HIV-propagation studies. It turned out that some people were apparently immune to the virus. They all showed the CCR-5 mutation on the corresponding gene. With the above-mentioned drugs, such as maraviroc, this genetic peculiarity is virtually simulated. For patients whose HI viruses are insensitive to many other drugs, this approach is very promising.
"Not detectable" does not mean "cured"
An undetectable viral load (this value describes the amount of HI virus in your blood) does not mean that the virus has disappeared. Very soon after infection, the virus infiltrates cells deep in the immune system, in organs as far as the brain.
The modern active ingredients in HIV treatment can not easily overcome the blood-brain barrier and do not come in organ cells or those of the immune system. This means that, for example, HIV “sleeps” in your body or replicates in very small quantities in the regions in question. However, the good news is that when therapy is started very early, HIV has fewer opportunities to hide deep within your body and form appropriate “camps.”
Despite all the efforts of science to find a way to completely eliminate HIV from the body, it has not yet been possible to overcome the corresponding cell barriers to the deep immune system or the organs. This is an important consideration in the search for a definitive cure for chronic HIV infection. At the moment, it is still a chronic infection that requires lifelong treatment.
How does the treatment work?
Left untreated, the HI virus infects your CD4 cells and other cell types in your body. So it uses your cells to replicate, making them produce millions of viruses. This process is also called viral flooding and will ultimately severely damage your immune system. This will make you vulnerable to serious infections and other dangerous diseases. The goal of HIV treatment is to slow down this process, ideally to stop it.
How does this work? There are different types of active ingredients, also called drug classes. Each of these classes of drugs attacks the HI virus differently. In your treatment, several drugs are used to fight HIV from several directions.
As a rule, viral replication slows down very quickly once treatment is started. The initially fast-paced virus flooding becomes a trickle. Because there are very few new viruses working in your body, the number of viruses, the so-called viral load, will drop. For many patients, the viral load is “undetectable” within the first three to six months after initiation of treatment.
By suppressing the HI virus, your immune system can recover. Your CD4 level rises again and all symptoms of HIV infection improve significantly or disappear altogether.
Prevention of mother-to-child transmission
HIV treatment can also prevent the virus from being transmitted to the baby during pregnancy, or to the baby during birth.
“What I keep trying to tell my patients is that HIV diagnosis is serious – you can not talk small. But if they make an effective antiretroviral therapy and we get together, then they can go well into old age. I always tell them then: Both of us will still be practicing in my practice when we are 102 years old! “
– Dr. L. M., specialist in infectious diseases
Before there were any effective treatments, every fourth baby of an HIV-positive mother was also HIV-positive. Now, with good treatment, the likelihood of giving birth to an HIV-positive baby is less than one percent.
In Germany it is usual that:
– an HIV-positive pregnant woman receives appropriate medication no later than the 24th week,
– the mother, when she is already in therapy, can be switched to suitable preparations,
– should be delivered in a clinic that has experience with HIV patients,
– the birth mode, ie caesarean section or spontaneous delivery, the mother decides
– the baby is given medication for a few weeks after birth for safety reasons
– advised against breastfeeding.
Breastfeeding has a low but real risk of infection, even if the viral load in the mother’s blood is undetectable. So if you are pregnant or would like to have a baby, talk to your doctor and he will also give you suitable alternatives to breastfeeding. In addition to the normal vial food, there is special food for your baby, which supports his immune system. Please talk to your doctor about pregnancy and birth issues, he will accompany you and your baby.
All these observations about the benefits of HIV treatment have a big impact on a good life with HIV. If you have questions about how to treat HIV, if you can prevent it with the medications, and what that means for you and your future, talk to your specialist for HIV.
PEP: HIV-negative people take HIV medication for prevention
This method is quite controversial worldwide. In Germany there is a kind of compromise: As a permanent medication, no, in acute case, yes. So if you had a “sex accident”, say the condom is torn or simply forgotten, and your partner is most likely HIV-positive and not receiving treatment, you can resort to this method of HIV infection to avert yet.
To do this you have to go to the nearest HIV outpatient department at least 48 hours after the contact, preferably with the partner or your partner, and describe the situation. You will then get HIV medication for a while, even if you are negative. This will prevent the virus from getting lodged in your body. If you take the medication strictly according to instructions, it is very unlikely that an infection will occur.
Depending on the type of virus you have to take the preparation for four weeks to three months. During this time, you should have your blood levels monitored closely because of side effects. In Germany, PEP (post-exposure prophylaxis), ie prophylaxis after a risk situation, is only offered in specialized practices and HIV centers. It is a very unusual route that is taken when a healthcare worker has been injured by an HIV-infected needle or a scalpel. As prophylaxis during or after sex, this is possible, but not common, because with a maximum of 48 hours, the window of opportunity for successful prophylaxis is very small. It is discussed whether a permanent PEP is permissible and advisable in individual cases. However, it speaks against the fact that the HIV virus “learns” immensely fast. And because PEP is done with common HIV drugs, there is a valid objection, for example to PEP, in couples with HIV positive and the other not that HIV virus resistance could be favored.
Regular HIV tests show at this time whether the PEP strikes. If the HIV test then turns out positive, fast action is needed.
Avoiding sexual transmission
Another great benefit of early treatment and keeping the viral load “undetectable” is that the risk of sexual transmission can be greatly reduced. The scientific results are sound.
The results of two large scientific studies, called HPTN 052 and the PARTNER study, showed that HIV-positive patients with undetectable viral load had HIV-negative sex, not a single transmission. All study participants were in a screening program to monitor viral load and had also been tested for other sexually transmitted diseases.
The HPTN 052 study followed. Here 1763 heterosexual couples were involved, one of which had the HI virus in itself, the other not. The study took place in 13 locations in nine countries. These couples mostly had vaginal intercourse. No transmission occurred when the HIV-positive person was under treatment and had an undetectable viral load.
The PARTNER study involved 888 couples, one partner was HIV-positive, the other not. Here both heterosexual and homosexual couples were involved. The study was conducted at 75 research centers in 14 European countries. All HIV-positive subjects were in treatment and had undetectable viral load. Although the couples had unprotected sex, ie neither used condoms nor taken prophylactic measures, no transmission took place 58,000 times in the couples who participated in the study.
Neither the presence of sexually transmitted diseases nor possible variations in viral load resulted in transmission. Even though a small number of participants became infected with HIV, both studies showed that this had happened either through sex partners outside the study, or when the HIV-positive partner had a detectable viral load.
Based on these findings, as well as others from other studies, we can assure that taking HIV medication and maintaining an undetectable viral load is a reliable way to prevent HIV transmission through sex. With or without a condom, if you are “undetectable,” you are not transferring HIV to a sex partner. For many people, this new reality is life changing: they get a complete view of themselves, their relationships and sexuality.
It benefits your health
We now know that getting treatment early, even before the virus can cause major damage to your immune system, has great benefits. The sooner you get your diagnosis and start the treatment, the better. This is always true, whether your CD4 + value is high or low.
A large study, the so-called START trial, confirms that. Scientists invited 4685 participants from 35 countries. The study participants were roughly divided into two groups: the first group started their treatment immediately, while the other group participants waited until their CD4 score fell below 350 or a serious illness appeared. The CD4 value indicates how strong a person’s immune system is. The value is determined by a blood test. Participants who started treatment immediately showed a significantly lower risk of developing serious illnesses such as cancer or life-threatening infections. This was independent of the sex, age and ethnicity of the participants.
These results confirm that the benefits of starting treatment early outweigh the potential risks, but more so.
In Germany, the initiation of therapy is currently only recommended if the CD4 value falls, a pregnancy is present, an infection with hepatitis B or C has occurred, or if serious illnesses occur. Even in patients over 50 years, the start of treatment is recommended. There are advocates of an early start of treatment, but the fear of developing resistance is in conflict. Resistance means that the HIV virus in your body gets used to the drug, so that it no longer works. Since the virus is very mutational and even have been observed mutations in the patient, these considerations are still under consideration. Especially the adaptability of the HIV virus could weaken the efficacy of the drugs at an early start of treatment over time.
The benefits of HIV treatment
HIV treatment keeps people living with HIV healthy. It does this by suppressing the virus’s ability to copy itself. If you take your HIV medication every day, as you have been prescribed it, visit your doctor regularly, and keep the virus level below the limit of detectability, then treatment may be:
– control the virus and give your immune system the opportunity to recover – the sooner you start
– prevent the transmission of HIV to your sexual partners
– Women living with HIV will have healthy babies
– Significantly minimize the likelihood of transmission
– It benefits your health
– Prevention of sexual transmission
– Prevention of mother-to-child transmission
A better pill to swallow
HIV treatment has a turbulent history. If you’ve heard scare stories about early-stage HIV drugs – a bunch of pills that you need to take several times a day and that cause severe side effects – rest assured: modern medicines are much easier to take, much better tolerated, and more effective Effect more effective and safer. HIV treatment and what we know about it has changed profoundly in recent years. I’m sure you’ll like to hear that it’s a story with lots of good news.
“I’ve read blogs and learned of terrible side effects, also told me patients from the first years horror stories. That was not so long ago, that’s why it was what I thought HIV treatment is …
Over time it became so normal for me to take my meds, like brushing my teeth or going to the bathroom. It became my second nature. I noticed that all my fears were unfounded.
When my viral rate became undetectable, I regained the energy I had lost when I heard the diagnosis. My fear and bitterness faded and I felt more like the human being that I am.
For five years, I have never missed a dose. Meanwhile, I no longer see the intake of medication as a reminder of something negative, but more than something that finally gives me control over my health. Maybe the first time in my life. “
There are some very effective HIV medicines that are easy to take and have few side effects for patients in Europe.
Not only were the medications improved, but our knowledge of the treatment has grown as well. In the past few years, we have learned that the best thing to do is to start the treatment very early. You no longer need to wait for the right moment and think about countless pros and cons. The research impressively shows that early treatment minimizes the risk of serious illness. An early start of treatment is good for long-term success and life expectancy.
And there is even more good news: We have also learned that end-to-end therapy and HIV treatment that keeps your volume of virus “undetectable” will protect you from sexually transmitted HIV. So, if you regularly go to the doctor and take your medication so that your virus level remains “undetectable”, you do not put your partner in HIV with HIV. The virus is still in your blood but the amount is so low that an HIV routine test will not respond.
We also know that HIV treatment significantly reduces the risk of transmission from an HIV-positive mother to her baby during pregnancy and childbirth. For example, HIV-positive mothers can experience a healthy pregnancy and give birth to a HIV-negative child. Even the risk of sharing syringes is significantly lower with HIV treatment.
The HIV treatment is not only good for you, but also for those you love. If you are someone living with HIV, starting and continuing treatment is the best thing you can do for your health
“Knowing what you’re up to is a good thing … you’re still the same person you were before you got the diagnosis. Take your medication and keep your health in order, in the end it will even do you better than the average person. “
What is HIV treatment?
HIV treatment is known by many names: combination therapy, antiretroviral therapy, highly active antiretroviral therapy and simply HIV medis, for example. We just stick to the term HIV treatment here.
During HIV treatment, several active ingredients, usually three or four, are taken daily to stay healthy. Although many people take only one tablet a day, it contains several different active ingredients.
Since there are many active ingredients and many possible combinations, there is a good chance that you will find a treatment that will work for you with little or no side effects.
Finally, effective HIV treatment allows a healthy and fulfilling life for HIV patients.
What you learn in this guide
Here we explain what we know about HIV treatment. What is this exactly? How does it work? What has changed? (A lot – and for the better) We will also look together at the benefits of starting treatment early and how the treatment can prevent the spread of HIV.
In this guide, there are people who live with HIV and who have gone through what you are about to face.
Your therapy team
Your treatment team is an important factor in making your therapy successful. You will go to the doctor regularly and together you will plan and monitor your treatment. Try to find a doctor who is familiar with HIV and with whom you feel comfortable. Openness and trust are very important.
Other members of the treatment team
“My advice is: Collect information, get smart about HIV: What does it matter? What help is there? The more you know about yourself and the virus, the better you can take care of your health and stay fit … you do not have to do it on your own. Make connections, build a network, and learn to speak openly with your doctor. “
Your treatment team is not just your doctor. He has assistants or nurses in a clinic. There you will also find other professionals such as social workers, therapists and psychologists. All of these people have important skills and opportunities to support you. They can also give you a lot of practical advice, such as how to finance the treatment or who in your environment you need to say much about. Often they just have more time to talk to you than the doctor. An assistant or nurse can also answer some medical questions when the doctor is busy.
Of course, you will also meet regular pharmacists, namely, when you get your medication. They can also tell you everything about active ingredients and what they do. They can advise you when taking them, so that there are no interactions or even allergic reactions. In order to avoid interactions, it is good if you get all medicines in a pharmacy. Especially if you get recipes from several doctors. Pharmacists can also give you valuable tips on how to improve the tolerability of the medication and where to go if the health insurance company does not pay for all the supplements.
Some patients go to a general practitioner or family doctor who is familiar with the treatment of HIV patients. Others prefer an infectious disease specialist. They go to the family doctor with other health problems, which may occur next to HIV or as a concomitant.
It is important to have a doctor who is familiar with HIV treatment and who is getting on regularly. In Germany there are specialized practices throughout the country, the addresses can be found on the Internet. Even larger hospitals, especially university hospitals, usually have a ward for infectious diseases or tropical medicine. Here you will find highly qualified specialists who can look after you. Information about doctors in your area can be obtained from the German AIDS Help e.V., other HIV self-help groups and the health department.
If you have the opportunity to vote, have a look at several doctors. Talk to them, ask them. It is important that you can trust your doctor. That you can talk to him openly, feel good about him and that he is open and respectful with you.
If you talk to your doctor, then there are no “stupid questions”. After all, it’s about you, your life, your health. If you do not understand something, ask quietly. Let everything explain exactly and ask for technical terms.
Talk in detail with the doctor about the treatment: What successes are possible? What side effects can occur? Can other health problems occur and if so, what will be done? Are there alternatives? Maybe you want to take your partner, your partner or even close friends for a conversation. That’s okay and no doctor will mind. It’s also ok, even good if you take notes during the conversation. You may also want to release your doctor from confidentiality vis-à-vis your spouse, wife, or close relative. This can be very helpful under certain circumstances.
You can also do a few things between appointments to monitor and track your health development.
Your health diary
Whether written or as an app, a health diary is very useful. Carry all your allergies and medications. Write down briefly every day how you feel and, of course, if side effects or health problems occur. You can collect your test results here as well as medical advice and appointments. So your entire treatment team always has all the information and even in an emergency you can be helped quickly and effectively. If you like, also note the questions that you would like to ask your doctor.
Other members of the treatment team
The start of treatment
In terms of your own well-being and also for the success of your therapy, it is important to be prepared. And physically, mentally and mentally.
Before the treatment starts, your doctor will advise you on various blood tests. It is examined whether you are allergic to certain drugs or whether the virus is insensitive. He or she will also ask you if you regularly take other ingredients or additives to make sure the preparations work well together. The HIV drugs that you and your doctor choose depend on other health issues as well:
What should be your first combination?
The drug group for the start of therapy is clearly defined. At the moment therapy guidelines recommend some clearly defined entry-level combinations.
Cost of therapy
In Germany, the statutory and private health insurance companies bear the costs of HIV therapy. However, you may be getting so-called generics. These are preparations containing the active ingredient prescribed to you, which are produced abroad or by another, more favorable company. The efficacy is the same, but there may be other adjuvants in the tablet that you may not tolerate. So if you need the original preparation, your doctor will confirm that. This confirmation you send to the health insurance, then you get the original.
You only have to pay the legal own contribution (“prescription fee”) yourself. Again, there is a possibility in Germany: You can get rid of the prescription fee under certain conditions. How exactly is, is different from health insurance to health insurance. It is best to check with your cashier, they will tell you what you have to submit and where the application for exemption must be sent.
If you are privately insured, then you must, as with all other treatments and medicines also, first advance payment. This is also the case for the insurance of civil servants. You then submit the recipes and get the amount back. Attention! Some private health insurers only partially reimburse certain benefits. The best way to look at your insurance contract is to see if HIV medications are part of these “extraordinary services”.
Plan the intake
It is important to find a treatment that fits your planning. For example, most HIV drugs have no dietary requirements. But some should be taken on an empty stomach before a meal. Talk to your doctor to make a plan that suits your life. Meanwhile, HIV therapy is easier than ever. Many patients take only one tablet a day.
Occupation and social facilities
“Understand your lifestyle and habits and talk openly with your doctor. This can help to find the right treatment for you. And do not forget why you are doing the HIV therapy. The beautiful days and years ahead of you are worth the little inconvenience. “
Do your family, friends and colleagues or roommates need to know that you are HIV positive? Can medication intake or medications be at home or at work can be a problem? If so, think of something that rules out that someone you do not trust will learn about your HIV. Where will you keep your meds? When and where do you want to take them?
Compliance with the revenue regulations
For your treatment to work, you have to keep to the exact time of taking. It can take a lot of getting used to taking medication every day at a certain time. Think about your daily routine and if you need to change something about it, so that the tablet intake fits into it. Understanding the benefits of the treatment will certainly motivate you to take a few pills. There are also many tips and tricks to help you. For example: Do you brush your teeth every morning at seven o’clock? Very reasonable! After cleaning you take your meds. You already have a fixed time that you will not forget.
Other health issues
Talk to your doctor about it if you are
– belong to the risk group for cardiovascular diseases. This is the case if you smoke, have a high cholesterol, are very overweight, are related to cardiovascular patients, or are taking drugs such as amphetamines or cocaine. Both HIV and some HIV medicines can increase the risk of cardiovascular disease. So the right combination for you will be without these ingredients.
– you have hepatitis B or C or other liver disease, tuberculosis, kidney disease, , depression or other mental illnesses you are treated with medications. Some drugs are not right for you then.
“I’ve had serious side effects with my old meds … I got my new ones in August 2012. Thankfully, HIV meds have come a long way. I do not have any side effects anymore. My meds and I get along very well. “
“When I had to choose my first combination, I was lucky due to several options. I was worried about how my body would change and I wanted something that would be easy to take …. At first I had nightmares and mood swings. These side effects still happen sometimes, but mostly I’m fine. “
Most patients have no side effects with the new HIV medications. Furthermore, we know that the sooner the treatment is started, the lower the likelihood of major side effects.
Nevertheless, side effects are possible; they may occur, but they do not have to. If you get side effects, they may disappear soon. Others can be counteracted with over-the-counter remedies, such as a headache tablet or an itching medication. Each ingredient in your combination has side effects, some rare, some common. But that does not mean that you will get them all or you will have them at all.
Ask your doctor or pharmacist about the most common side effects of your combination and what you can do to control them if they happen.
If you are pregnant or would like to become pregnant, please tell your doctor. This is important information to find the optimal medication for you.
If one active ingredient changes the effect of another, ie, strengthens it, weakens it, triggers side effects, or even creates new ones, then it is called an interaction. It is very important to select HIV drugs that do not interact with other drugs that you take.
Talk to the doctor about all the drugs you take. Really all, so prescription, over the counter, herbal or dietary supplements. So possible interactions can be limited. Sometimes drugs should not be taken together. Sometimes you can continue taking both drugs, but not at the same time, for example.
You may be hypersensitive or allergic to certain substances. Surely you have heard of cases in which someone has suddenly suffered a life-threatening allergic shock after taking a harmless remedy. Here, the allergy to this substance was apparently unknown and became acutely life-threatening. There are also creeping allergies, in which the body triggers a process every time the allergen arrives, which can gradually damage organs. A simple blood test before the start of treatment ensures that possible allergic or hypersensitivity reactions can at least be considered as very unlikely.
Ask your doctor the best about the hypersensitivity reactions that can be caused by an ingredient that you take. So you can act immediately in an emergency.
Insensitivity to drugs
Insensitivity to drugs refers to the HI virus and its mutagenicity. There are now types of viruses that slow down certain drugs or do not respond to them. Drug-resistant HIV strains can also be transmitted from person to person. So someone who has never had HIV treatment can be infected with a resistant strain. Also in the patient, HIV can change and eventually become resistant to a drug or a combination. If someone who is in treatment always forgets revenue, then the virus can mutate and become resistant to the drug.
All patients starting HIV therapy should be screened for resistance. Even with a change of the preparation, this may be useful. This test indicates which supplements are not effective against the virus in your body. Thus, the test can help even before the start of therapy to narrow down the active ingredients in question for you. That saves you a lot of time.
For the treatment to work
Once you start taking your HIV medications, they should work. In this area, we look at factors that contribute to the success of treatment. The intake strictly according to prescription (adherence) is crucial for the long-term success of the therapy. Here are some tips and tricks that helped others. Your doctor and you will monitor your health and document therapy success.
Discontinuation of therapy?
In a nutshell: no way! HIV therapy is a permanent, lifelong necessity. The reason is that the virus can persist in the body cells for a very long time. If the treatment is stopped, the virus production can start very quickly and run even faster than before.
If for any reason you need to stop therapy, your doctor can tell you how to do it without the medication in you becoming ineffective.
Change of therapy
Sometimes you want or need to change your therapy. There can be several reasons for this:
– Sometimes a therapy can not effectively control the viral load
– Despite good values, a side effect can be unbearable
– A newer and better tolerated HIV drug has come on the market
You need to do the changes with your doctor. Stop taking medication just like that. Sudden discontinuation of medication can have unforeseen consequences, including that your HIV becomes resistant to the drug.
– If the treatment does not work
– If you have side effects
– When a new therapy seems better
If the treatment does not work
Your viral load is the best indicator of whether your treatment is working. If that is the case, the value drops to “undetectable” and stays there. If, after six months of treatment, your viral load is still detectable, it may mean that the treatment is not working. Even if you were “undetectable” and then the viral load is detectable again.
Your doctor and you must then consider why the therapy does not work. Often the reason is that too many revenues have been missed. It must also be found out if your virus has become resistant to any of the active ingredients.
Resistance tests can show which substances the virus responds to and what it does not react to.
If such a test shows that you have a resistant virus, you and your doctor need to find a new combination that works. Your new combination should contain three agents that your virus responds to. Here is the experience of your doctor asked.
When side effects occur
“I’m still on my second cocktail. Except for a huge depression in the drug change, I have no side effects. My viral load has not been detectable for several months. ”
If your treatment successfully suppresses the viral load, but you feel bad, talk to your doctor.
Many side effects disappear after a while. Others can be improved with over-the-counter medications or if you change the time of taking them. Your doctor and pharmacist will advise you. Maybe your doctor also recommends switching to another combination that makes you better tolerated.
If another combination seems better
Some people take the “Why repair something that is not broken?” Attitude to their treatment and leave a combination that works the way it is. Others want more comfort and a treatment that suits their lives better. Or is it that your treatment works and you have no side effects, but there is still something new that is better than your current meds?
Talk to your doctor about new therapies that you have heard about and let him inform you about developments. Your doctor can help you decide if you should change the medication. If so, it will help you to make it as comfortable as possible and to avoid possible resistance.
In Germany, people are not quite sure about the right moment to start treatment. In any case, when signs of illness occur, if you are over 50 years old or if you become pregnant. Talk to your doctor, he will advise you and find with you YOUR right moment for the start of treatment. The costs of medicines are definitely covered by the statutory or private health insurance companies, as well as the treatment of secondary diseases. Macabre but true: even the tax office will meet you if your living costs increase due to the HIV infection. You can find out about all these things at advice centers and from your doctor.
And now we wish you all the best for your HIV treatment. We hope that we could inspire you and encourage you: for a long and happy life despite and with HIV.
How to see that the therapy works
“I’ve had some setbacks in the past few years. But when we made adjustments, I kept getting ‘undetectable’. If I have a setback, I’m sad, but I’m not afraid we could not fix it. It’s all easier for me now when it comes to my HIV. I am now focusing on living longer and getting older, with HIV and everything related to it. “
“Being ‘undetectable’ gives me hope for a future. It means the infection is under control. That makes me think of things other than being a host to HIV. “
“When I got my diagnosis, I had a low CD4 and high viral load. It was not long before my CD4 score was over 1,200 and for six months my viral load has not been detectable. In addition to taking a tablet every day, my life continues as before. I fell in love with someone who is HIV negative and we live in a happy relationship. “
The HIV therapy should press your viral load to “undetectable” and increase the CD4 value.
For most patients, it will take three to six months for the viral load to become undetectable. Some take longer, others faster. Some patients see the virus load occasionally flashing. Such a lightning means that the viral load with very little value – but short – becomes detectable and then disappears again. A single flash is not bad, but if several appear in a row, it may be that your combination no longer works properly. In any case, you should talk to your doctor about it.
If you have already had a low CD4 score in your diagnosis, your viral load will first drop before the value rises again. Once HIV is effectively suppressed, your immune system will recover very quickly and the CD4 level will rise.
Your treatment team will help you organize your intake and help you if you experience any side effects.
Many people who feel ill at the beginning of HIV therapy recover quickly. Patients in therapy are often much happier with themselves, their lives and their sex lives.
The monitoring of your health
“My family doctor is a full-blooded physician. He always takes extra time to listen to me and talk to me because he knows I was struggling with depression. He is there for me and helps and supports me. “
Regular medical check-ups to monitor your health are an important part of living with HIV. At these appointments, you can ask questions or tell your doctor about changes in your condition. He will examine you thoroughly over and over again to pay particular attention to certain developments.
Again and again, blood will be taken from you and sent to the lab. This is especially necessary in the first year of treatment. Two very important values are monitored: your viral load and your CD4 value. Further routine examinations can detect health problems at an early stage, even if you do not have any symptoms yet.
How are you? Whenever you see your doctor, you should tell how you feel, especially if something has changed. This also includes changes in your mood or your mental health. If you feel sad and depressed, please say so. Maybe your doctor will ask you a few questions to find out if you need any therapeutic support.
Your viral load – It describes the number of HIV-causing agents in your blood. The result is shown in the number of RNA, ie the genetic material of the HI virus, per milliliter of blood. Without treatment, millions of these RNAs may be found in the blood sample.
“I’m happy every time I get the result” undetectable “every three months. It means I do not have to change my therapy and everything is fine until the next test. It is encouraging and a great reassurance that things are going well. Being multi-drug resistant, it’s very relieved to hear that my prescriptions are not changing. “
The standard test in Germany is called ELISA. In several steps, enzymes are used to isolate and stain HIV antibodies using enzymes. Since this test is very sensitive, false-positive results are possible. In case of such a result, a control test MUST be performed. No matter how accurate the test is, absolute safety is achieved with the so-called NAT. The abbreviation means Nucleic Amplification Test. The virus has certain protein compounds (Nucleins), which are stimulated in this test to increase. These are typical for every virus, so the result is absolutely clear with this procedure: If there are no HIV-nucleic acids, the test will not signal.
Also common in Germany is the PCR test. It can also be used to determine the viral load. However, this test has one major drawback: it can only detect HIV-1, but not type 2. It can also be false-negative in patients who are infected but whose immune system still has the virus under control.
If your viral load is undetectable, that does not mean that you no longer have HIV. It just means that the amount of virus in your blood is so low that the usual tests do not respond. If you do not take your medication regularly, the viral load will increase again.
Your CD4 score – It shows how strong your immune system is. The CD4 value drops as viral load increases and vice versa. You should check this value regularly. Your doctor will suggest an interval for this. A normal CD4 score is between 500 and 1500 in a healthy, HIV-negative person. The sooner you start treatment, the more likely your CD4 level will be to stay high or rise again.
Read more about healthy living
Compliance is the key!
Today, HIV therapies can be very simple: Some patients only need to take one tablet a day to keep the virus under control. However, one thing has not changed: HIV therapy is a lifelong task that requires taking medications every day, exactly as prescribed. That is meant by compliance.
Your therapy will only work if you do it every day. Keeping exactly on the time of use is important because the active ingredients are quickly flushed out of the body. But it is a certain serum level (drug content in the blood) needed to keep the virus under control. If you fail too often to take your medications, the viruses will develop resistance and the drug will no longer fight your HIV. Even if there are other combinations, it is still better to keep your current one effective for as long as possible.
“All my patients know my pills mantra: ‘If you take that in, it will work and maybe even forever. So let us work together to take your antiretroviral medis every single day. Get sent reminder SMS, load suitable apps on the phone, set alarms, or stick your notes to the mirror. Whatever is needed! ‘I tell people that most of us have to make bigger concessions in other areas than to take a pill once a day and go to the medical check-up regularly. With effective therapy and complete treatment, HIV can be very easy to master. “
– Dr. L. Jansen, specialist in infectious diseases
Your doctor or pharmacist will help you to keep it. Talk to them about it.
Here are a few tips:
– Always take your medication at the same time of the day.
– Put a reminder alarm in your mobile phone. This can be especially helpful when you’re on the move. You can also load corresponding apps.
– Keep your meds next to the bed or in a closet because you keep opening. Then you see her several times a day and do not forget her.
– Put a few tablets in places where you are often. At your workplace, with your parents, or with your partner.
– If you are traveling, plan ahead. Take enough pills for the holidays and a few more. Take also the follow-up recipe and put everything in your hand luggage. If the other luggage is lost, you are otherwise without meds.
– Take a Dosette (Pillbox made of plastic) and always fill it with the amount of tablets for a week.
– Make sure you never run out of meds.
– Ask other HIV patients how to organize their medication.
– Ask friends and relatives to remind you to take it.
If you find it difficult to take your meds as prescribed by your doctor, do not be afraid to ask for help. Maybe you are traveling a lot or your life is just chaotic or you are depressed. You may also be taking drugs or it is a problem to dump your HIV medications at home or at work … all of which can make it difficult for you to comply with the prescription. Maybe you forget it easy to take the meds. Whatever the reason, you are not the only HIV patient who has to deal with such things. Talk to your treatment team or a support group, they will support you.
Compliance can be very challenging. If you forget a dose, that’s not the end of the world. But then try as soon as possible to get back into your income rhythm. This will ensure that your combination stays in effect for as long as possible, and that’s the best thing you can do for you in the long run.
Besides taking your HIV medication, the best way to live well with HIV is simply to live well. As the saying goes, “The best revenge is a good life”. Here are a few ways to show you how to live a better, healthier and more relaxed life so that you feel comfortable. Finding a healthy middle ground in your habits helps you to live well with HIV.
Dealing with stress
Make time in everyday life to do things that you like.
Stress is best released when doing things that are fun. Take time to go out, meet friends, cook, work in the garden or for a nice walk. And it is very important to spend time with your loved ones.
Other ways to deal with stress are:
– Learn meditation and breathing techniques – you can take a course or get literature and music on the internet
– Yoga or Tai Chi
– Massages (the doctor can even prescribe you)
– Take breaks, short and long. Take a nap, stay home for a day, or drive away for a few days.
Tips for reducing stress
Make sure to drink a lot. Best water or tea. Our body consists of three quarters of water and with plenty of fluid you help it to flush out toxins. About 2 liters a day are good.
Eat lots of fresh fruits and vegetables. For example, make yourself different smoothies, so get a real vitamin kick, which also tastes very delicious. Remember how well you feel when you are optimally nourished. Avoid processed foods. If you need to shop fast in a supermarket, avoid the main courses! There are all the processed food around.
Turn down a corridor. Enjoy the moment. Be careful and present. Rest and relax. Let yourself be massaged to stimulate your circulation and your immune system.
Believe in yourself – Listen to your inner voice. Keep a journal. Fulfill a dream. Learn the power of the will. Express a wish or pray for something and do not be surprised if you get it. Do not forget to be thankful.
Rejoice – Celebrate it by doing things that you enjoy, or find a new hobby. Learn something, sing in a choir, or go into a salsa course.
Do sports- Make your heart beat faster and your blood racing. Do not forget to breathe! Run, swim, dance … no matter what. This will not only do you good physically, but also lift your spirits. By the way: sex is also training!
Compliment Yourself – What you say can hurt you or heal you. We are always very quick to scold us. Turn that around! Praise yourself! Tell yourself how great you are because you made something.
Get help – ask your local HIV group. You might know possibilities and programs that make your life easier and you have never heard of. Search contacts over the Internet or in other ways. Exchange with other HIV patients. Get help from family and friends. Celebrate your relationships.
A strong body is better able to fight HIV. In addition, sport can help you reduce stress.
For many HIV patients, sport is an important aid to well-being. A trained body can fight the virus better and some physical fitness helps to cope better with stress. Furthermore, a good physical fitness reduced the risk of becoming depressed. Last but not least, regular exercise will also help you with weight control. Jogging, walking, cycling and other aerobic sports will promote your health. But watch out! You should not overdo it, especially if you are just starting out. Talk to your doctor before you team up with a trainer to show you how to work out optimally. Sport can also help with rehabilitation.
Sport can cause you to:
– more energy
– less stress
– better heart-lung function
– restful sleep
– regular intestinal activity
– a better self-image and
– have more self-confidence.
For a permanent weight gain you have to work with weights and increase the protein and carbohydrate intake (only complex carbohydrates, please).
It may be necessary to gain weight and build muscle mass if you have lost a lot of weight due to HIV. In order to gain weight, which will remain, you will need to lift weights and eat more proteins and healthy carbohydrates. Fat food is the wrong way! For weight training, the corresponding machines in the gym are best. Pushups, situps and the like are good as well, they use your own body weight as resistance.
Tips for your work-out:
In training you should:
– breathe (exhale with exertion helps a lot)
– wear comfortable clothes
– drink a lot, before, during and after training
– warm you up and down
– pay attention to your body
– feed you well
– always take breaks and training-free days
Your body produces its own antioxidants, but they are also available in some foods. They are important because they eliminate the so-called “free radicals” in the body. It is now known that these free radicals damage cells and should therefore have nothing to look for in the body. HIV can aggravate this cell damage, so these free radical protectants are very important.
As we increasingly understand the role of inflammation and oxidative stress in the health of HIV patients, a diet rich in antioxidants should be sought. Especially when we age, the own production decreases. In HIV patients, this may increase the susceptibility to cardiovascular diseases, liver and kidney diseases and the like.
Foods rich in antioxidants include blueberries, red wine, red pepper, spinach and green tea. There are also dietary supplements with antioxidants, such as vitamin C and E supplements, coenzyme Q10, selenium zinc and the so-called NAC, an amino acid compound.
Vitamin B complex
Vitamin B complex is related to our energy balance and also strengthens our nerves. This vitamin group is also important for the skin and hair. Vitamin B12 deficiency is also associated with anemia, limited ability to concentrate and low energy. They are included in bananas, potatoes, tuna and other foods, for example. If your vitamin B12 level is too low, your doctor may treat it with an injection.
Vitamin C is one of the most important antioxidants and is also called ascorbic acid. It is contained in citrus fruits, peppers and many other fruits and vegetables. Vitamin C can cause diarrhea in high doses. The need for this vitamin is usually sufficiently covered by the diet.
Vitamin D is formed in the skin by solar radiation. It has an important role in calcium metabolism and is responsible for strong bones. Other functions in the body are also dependent on him. It is believed that the “winter blues” are related to vitamin D deficiency. In winter, it may be useful to take a vitamin D supplement.
Vitamin E inhibits inflammation and promotes cell regeneration. It is found in nuts, avocados and green vegetables. High vitamin E doses are toxic! In addition, too high a vitamin E intake seems to favor heart disease.
Calcium is the building block of our bones. Some HIV drugs may affect calcium intake. Older people as well as menopausal women also have a higher calcium requirement, otherwise the bones will become porous and threaten osteoporosis. An indication of calcium deficiency is, for example, the increased occurrence of muscle cramps. In the diet it is contained in dairy products. If you are thinking about supplementing with calcium, take it slowly. Sometimes calcium can cause constipation.
Most European country kitchens use food that provides adequate iron supplies. Nevertheless, you should have your iron value checked now and then, because from this substance, the red blood pigment is formed. This in turn is important for oxygen transport, so the performance. Iron also plays an important role in the immune system. Supplements with iron supplements should be prescribed by the doctor. In the diet, red fruits and red juices are an important source of iron.
The trace element selenium is important for thyroid function. It occurs in nuts, fish, eggs and cereals.
The trace element zinc is very important for the immune system. Almost all meats contain zinc, as do poultry and seafood. Like pumpkin seeds, milk, beans and brown rice.
Other nutritional supplements for HIV patients
Good also can be:
– Alpha lipoic acid
– NAC (N-acetyl cysteine)
– Coenzyme Q10
The vitamins and minerals your body needs
A healthy lifestyle should give you all the substances your body needs. Because of their lifestyle or because of the medication, it is sometimes difficult for HIV patients to get all the nutrients they need from their diet.
For medical reasons or because of your lifestyle, it can lead to deficiency symptoms. It is therefore advisable to take a multivitamin daily.
HIV or some of the drugs you need to take can make it difficult to take vitamins from your diet. Therefore, it is certainly good to take a multivitamin supplement.
Your treatment team can work with you to find out if you lack certain substances or if you can not get enough from your diet. If so, supplements are a good help. Your doctor, nutritionist or other contact persons can advise you on all questions about HIV and the meaning of nutritional supplements. Make the supplements fit your body and not interfere with other ingredients you take.
Good nutritional supplements you can get in the pharmacy. They cost a little more, but are worth their money. Certain vitamin supplements can also be prescribed in Germany. Then you get them on prescription, like your other meds too.
Nutrition and HIV agents
Some HIV drugs need to be taken on an empty stomach. As a precaution, ask for nutritional requirements so that your meds work optimally.
Some foods react with HIV drugs. More specifically, some foods alter the absorption rate of the drug into your body. Please remember to ask your doctor or pharmacist if you need to be aware of something when you are taking it, such as being sober or not sober. This is very important for the active ingredients to work optimally.
An untreated HIV infection makes the body more susceptible to infections caused by harmful bacteria in food and water.
In the period before effective HIV medication, many HIV-infected patients suffered life-threatening bacterial food or water infections. Even though life-threatening infections are no longer the problem, as there are HIV medications, you should follow the rules for food preparation:
– clean hands and surfaces before you prepare food
– Always cook meat and seafood completely
– Fruit and vegetables should be washed or peeled
– Do not eat anything that has passed its expiration date or is corrupted
– Keep raw meat or seafood away from ready-to-eat food. This also means: do not use the same boards, plates or knives for raw meat or seafood and ready to eat food.
– Do not store foods that have not been refrigerated for a long time, especially if they are perishable. Warm things have to be kept warm, cold and cold
– Pay attention to warnings about contamination in food
The safest is the food you prepare yourself at home. When eating out, it may be better to avoid foods that are not cooked properly, especially fish, poultry and meat.
Carbohydrates, fats, proteins
On carbohydrates, fats and proteins, the diet builds up. They deliver the energy you need to manage your daily routine. This energy is usually measured in kilocalories or kilojoules. Knowing your basal metabolism, the amount of energy your body needs based on your gender, age, height, and lifestyle, can help you control your calorie intake.
Carbohydrates are an important source of energy in the diet. They release the energy slowly and evenly and should be eaten regularly.
There are two groups of carbohydrates: the simple and the complex.
Complex carbohydrates can be found in whole grains, legumes, fruits and vegetables. They are considered healthy because they stay in your body for a while, slowly releasing their energy and also raising blood sugar levels only moderately. The foods with complex carbohydrates are usually very rich in vitamins and fiber.
Simple carbohydrates are found in “white” food. So in sugar, white flour and processed foods. They cause your blood sugar to rise and then crash again just as quickly. This can make you feel exhausted. Simple carbohydrates are not as high in nutritional value and properties as complex ones.
Try to eat more complex carbohydrates. This is easily done by grabbing whole wheat products.
Make sure your diet contains healthy fats. These include unsaturated, or monounsaturated fatty acids and all omega-3 fats. They support the health of your heart.
All kinds of bad things about fats have been heard in the past few years. However, they now know that they are an important component of a healthy diet because they provide the highest energy density in our diet. There are healthy and unhealthy fats. As an HIV patient, you should be very careful to eat lots of healthy fats.
Unsaturated and monounsaturated fatty acids as well as omega-3 fats are found mainly in vegetable oils and vegetables. Good sources are: olive oil, linseed oil, rapeseed oil, nuts and avocados. The best omega-3 source is salmon, especially wild salmon.
Saturated fats and trans fats are not good for your health. They can clog your blood vessels and increase the likelihood of cardiovascular disease. For HIV patients, it is sometimes important to avoid these fats because some HIV drugs increase the cholesterol level and thus increase the risk even further.
Saturated fats usually come from animal sources. They should only be consumed in small quantities. Trans fats are mainly included in processed foods. Fast food and snacks are to be mentioned here. They are used for Garbeschleunigung when baking or frying and are considered harmful to health. It is recommended to avoid them altogether.
Food labels contain all nutritional information. It is worth reading these before you buy your food. So you can specifically take what you really want to eat, and avoid anything that could harm you.
Proteins are another important part of your diet. They help your body build hormones, enzymes, cells and parts of the immune system. Another important factor is maintaining and building muscle mass. You can find proteins in all types of meat and fish. Also in seafood, eggs, legumes, dairy and nuts. Soy is also an important protein supplier.
Please note that there are several underlying diseases that do not allow much protein in the food. These include kidney disease, which can be made worse by the intake of a lot of protein. It’s best to ask a doctor or dietitian how much protein is advisable for you.
Hold your weight
Maintaining a healthy weight is challenging for many HIV patients – some are prone to losing weight, others are rapidly gaining weight.
The redistribution of body fat associated with some HIV drugs does not make it all easier.
Of course you should feel good and look good. But just as important is that you get all the nutrients. Learn about healthy ways to lose weight and gain weight. One-sided diets do not work! If you want to gain weight, avoid saturated fat, but look for foods that otherwise provide a lot of energy. It is best if you follow a sports program in addition to your diet. Before you change your weight, such as through diet, please talk to
The right diet
A good, balanced diet with fresh, untreated foods is vital to your health.
The German Nutrition Society advises the following:
– Five servings of fruits and vegetables a day
– use the whole grain variety for cereal products
– eat animal products such as milk, yogurt and cheese daily
– resort to healthy fats
– gentle preparation of the food
That sounds like a whole lot of food, but here the conditions are decisive and not the actual amount. For example, an apple is already a serving of fruit a day.
Of course, the German Nutrition Society only mentions very general guidelines. It does not discuss whether perhaps for cultural reasons certain meal rules should be respected, nor the specific needs of an HIV patient. The best way to talk to your doctor or a suitable nutritionist about how you can eat optimally.