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The Importance of Access to Medical Care
As the medications that are available to treat HIV infection have become more numerous and complex, HIV care has become a medical specialty. If possible, people who have HIV infection should seek out a physician who is skilled in the treatment of HIV and AIDS.
Despite the efforts of researcher who have worked for years to develop a vaccine to prevent, or alleviate the severity of HIV infection, there is currently no vaccine for HIV. No one knows when a vaccine will be ready for distribution. Many promising developments have been made and it is possible that a vaccine will be available within this decade. Currently, prevention is still the only way to avoid HIV infection.
Case Study #7
Mr. S. came to the HIV clinic as a walk-in. He claimed to be homeless, actively using drugs, and had no income. He was diagnosed with HIV about eight years ago and had been seen in different clinics on an intermittent basis. He moved to this area about one year ago to attend a rehab program, but relapsed and was living on the street or in shelters when there was room. He took antiretroviral therapy while he was in rehab, but had been out of all HIV medications for at least three months. He noticed thrush in his mouth and he has had a sore throat. He wanted an urgent appointment to get a supply of medications.
The nurse explained to Mr. S. that he could be seen by a provider as an urgent visit, and he would also be seen by a social worker who would determine what other urgent needs he had. After being assessed by both staff members, the decision was made that the patient appeared to be medically stable and would not need emergency intervention. The plan was to obtain labs and past medical records, and attempt to help the patient find stable housing prior to restarting HIV medications. The social worker contacted someone at the Department of Social Services who agreed to provide an emergency housing voucher for a nearby supported living program. Staff at the program provided transportation to apply for social services including food stamps and disability. They took him to the food pantry and back to the HIV clinic for his next appointment. Finally stabilized, Mr. S. was able to keep his clinic appointments and take his medications appropriately. He reconnected with the rehab program and made arrangements to attend on an out-patient basis. He has been clean and sober for about four months. He is very appreciative of the support he feels from his provider, social worker, and staff at the clinic.
The Impact of New Drug Therapies on HIV Clinical Progression
Before 1996, there were three medications that were available to treat HIV. These drugs were used singly and were of limited benefit. Researchers in 1996 discovered that taking combinations of these medications with new medications called protease inhibitors dramatically reduced the amount of HIV, or "viral load," in the bloodstream of a person infected with HIV. Two or three different medications are used in combination. Each one targets a separate part of the virus and its replication.
The reduction of deaths from AIDS in the United States has been primarily attributed to this combination therapy, called highly active antiretroviral therapy (HAART).
Because medications for HIV treatment are updated regularly, please consult those organizations that list current medications used in the treatments for HIV/AIDS. One such website is: http://www.aidsmeds.com/lessons/DrugChart.htm. Access to HAART, adherence to the medical regimen, and response to HAART affect whether or when HIV progresses to AIDS.
However, not everyone with HIV infection benefits from the new drug therapies. Many people cannot tolerate the unpleasant or serious side effects from the medications. An estimated 40-50% of people with HIV who have access to the improved medications are either unable to tolerate them or cannot adhere to the complex treatment schedule. If a person cannot keep this complicated schedule, the drugs do not work effectively and viral resistance may develop.
Insurance programs and government programs for individuals with low income pay for much of the cost of the HIV medicines in some states. These medicines may cost several thousands of dollars per person each month. People who live in other countries where the medication is unaffordable have almost no access to the newer therapies.
Although the new drug therapies work for many people to keep the amount of virus in their bodies to very low levels, they are not a cure for HIV. Once therapy is discontinued, viral load may increase. Even during treatment, viral replication may occur and the person remains infectious to others.
Many people find that after time, the virus becomes resistant to the medication, and they must change medications. This is especially true when the medications are not taken correctly, and it limits the number of possible drug therapies that the person might be able to use.
Side Effects of HIV Prescription Medications
Patients often have unpleasant side effects when they use prescription medications to treat their HIV infection.
People have used and relied on alternative, sometimes called complimentary, therapies to treat HIV infection for as long as HIV has been known. Many people use these treatments along with therapies from their medical provider. Other people choose to only use alternative therapies.
These therapies include a wide range of treatments, from vitamins, massage, herbs, naturopathic remedies, and many more. It is important for people who are taking alternative therapies to tell their medical provider. There may be drug reactions or other harmful side effects from the interactions of the "natural" medicine and antiretrovirals.
Other drugs, including over the counter medications, prescription medications and "street drugs," may have serious interactions with antiretroviral medications. It is extremely important that people on HIV medications tell their healthcare provider, pharmacist or social worker about all other drugs they take.
Case Management
People living with HIV often seek the assistance of a case manager who can help explain the different types of services available.
Children with HIV may also benefit from the "Children with Special Health Care Needs" program. Care coordinators for this program are located at every county health department/district.
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