Until now, there has been no curative management to treat HIV infection. However, Management of HIV/AIDS is given for life and aims to reduce HIV activity in the patient’s body so as to provide opportunities for the immune system, especially CD4 to be produced in normal quantities. Curative treatment and HIV vaccination still require further research.
Management of HIV/AIDS
Management of HIV/AIDS depends on the stage of the disease and any opportunistic infections that occur. In general, the purpose of treatment is to prevent the body’s immune system from deteriorating to the point where opportunistic infections will arise. Immune Reconstitution Inflammatory Syndrome (IRIS) which can appear after treatment is also rare in patients who have not reached that point.
For all HIV/AIDS patients are advised to rest according to ability or degree of pain, adequate nutritional support based on macronutrients and micronutrients for people with HIV & AIDS, counseling including psychological and psychosocial approaches, and getting used to a healthy lifestyle.
Antiretroviral therapy is the main method to prevent worsening of the body’s immune system. Secondary / opportunistic / malignancy infection therapy is administered according to the symptoms and diagnosis of the participants found. In addition, prophylaxis for specific opportunistic infections is indicated in certain cases
Management for cases of HIV (human immunodeficiency virus) is to provide antiretroviral therapy (ARVs) that serve to prevent the immune system from diminishing which risks facilitating the onset of opportunistic infections.
The principle of ARV administration uses 3 types of drugs with therapeutic doses. Types of ARVs that are routinely used:
- NRTI (nucleoside and nucleotide reverse transcriptase inhibitors) and NNRTI (non-nucleoside reverse transcriptase inhibitors): serve as a performance inhibitor of reverse transcriptase enzymes (enzymes that help HIV to develop and be active in the body of the patient)
- PI (protease inhibitors), blocking the process of HIV unification and maturation
- INSTI (integrase strand transfer inhibitors), prevents HIV DNA from entering the nucleus
ARV administration is initiated as early as possible since the patient is proven to have HIV infection.
First Line ARV for Older persons
The first-line ARV options for older persons are as follows:
- TDF (Tenofovir) 300mg + 3TC (Lamivudine) 150mg or FTC (Emtricitabine) 200mg + EFV (Efavirenz) 600mg: Generally in the form of FDC (fixed dose combination)
- AZT (Zidovudine) 300mg +3TC (Lamivudine) 150mg + EFV(Efavirenz) 600mg or NVP (Nevirapine) 150mg
- TDF (Tenofovir) 300mg +3TC (Lamivudine) 150mg or FTC (Emtricitabine) 200mg + NVP (Nevirapine) 150mg
TDF should not be started if CCT (creatine clearance test) < 50ml/min, or in the case of old diabetes, uncontrolled hypertension and kidney failure. AZT should not be used if Hb <10g/dL prior to therapy. A combination of 3 fixed doses (KDT) is commonly available: TDF+3TC+EFV.
HIV treatment can also be used to prevent the transmission of HIV from mother to baby. During taking antiretroviral drugs, the doctor will monitor the number of viruses and CD4 cells to assess the patient’s response to treatment. CD4 cell count will be done every 3-6 months. While HIV RNA examination is done from the beginning of treatment, continued every 3-4 months during the treatment period.
Patients should take ARVs as soon as they are diagnosed with HIV, so that the development of HIV can be controlled. Delaying treatment will only make the virus continue to damage the immune system and increase the risk of people with HIV developing AIDS. In addition, it is important for patients to take ARVs as directed by the doctor. Skipping drug consumption will make the HIV virus develop faster and worsen the patient’s condition.
If the patient misses the schedule of drug consumption, immediately take it as soon as remember, and stick to the next schedule. But if the dose is missed enough, immediately talk to the doctor. The doctor can change the prescription or dosage of the drug according to the patient’s condition at the time.
ARV Side Effects
During the first 1 month of ARV administration, it is important to evaluate to monitor the body’s response to treatment, both physical and psychological effects. Effects that are often felt at the beginning of the use of ARVs in the form of nausea, urticaria, giddiness / loss of balance, weakness, dizziness, and sleep disorders. This condition can arise in the early days of ARV use, and will decrease when ARV levels begin to stabilize in the blood.
Follow Up Therapy
Regular monitoring is carried out every 3 to 6 months. Monitored include complaints felt during the use of ARVs, physical examinations, to laboratory examinations especially CD4, viral load and baseline.
HIV Drug List
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