7 frequently asked questions about ARVs
There are several different types of antiretroviral drugs and they work in different ways. Our expert answers the most commonly asked questions.
Thanks to antiretroviral drugs (ARVs), being diagnosed as HIV positive doesn’t have to be a death sentence. HIV attacks the immune system, making it more difficult for the body to fight infections a generally healthy body would be able to fight off easily.
ARVs are given to slow down the speed at which the virus multiplies in the body. These drugs were first introduced in 1996. Starting in April 2004, South Africa has been rolling out a programme to provide free ARVs to those living with HIV to provide a longer, healthy life.
In 2016, about 19.5 million HIV positive people throughout the world were being treated with ARVs.
Even though these drugs cannot eliminate the virus, by slowing down its multiplication they can prolong the symptom-free period of the disease and allow the immune system to recover.
We asked our HIV expert Dr Sindisiwe van Zyl to answer the most frequently asked questions about ARVs.
1. Who should take ARVs?
Everyone who is living with HIV – regardless of CD4 count – should start lifelong antiretroviral treatment, says Dr van Zyl. To treat HIV infection, a patient must receive a combination of three or more different antiviral drugs which target different steps in the replication cycle of the virus. A cocktail of three different ARVs reduces the chance of the virus becoming resistant.
2. When should you start taking ARVs?
According to Dr van Zyl, your doctor or nurse clinician needs to do a proper clinical assessment and baseline blood tests. The goal is to exclude all opportunistic infections before starting a patient on lifelong antiretroviral treatment.
Before January 2015, medical professionals suggested starting ARV treatment when the CD4+ count starts dropping and the immune system is failing. Today it’s recommended that ARV treatment be started immediately when a person is diagnosed as HIV positive. Patients who are on antiretroviral drugs need to be monitored for evidence of drug side effects, evidence of clinical response to therapy (climbing CD4+ cell count indicates a recovering immune system), as well as for unexpected worsening of opportunistic infections.
3. What types of ARVs do you get and how do they differ?
Dr van Zyl explains that there are first-line, second-line and third-line treatments. “We always start with first-line treatment and choose the regimen according to the patient’s baseline blood test results and clinical condition. Whatever we choose, we need to ensure that you are taking three or more drugs. That is how we treat HIV – with three or more drugs.”
Each type of ARV drug attacks HIV in a different way. The first class of anti-HIV drugs was the nucleoside reverse transcriptase inhibitors (also called NRTIs or “nukes”.) Since then, many other forms of ARV have been used to fight HIV.
Antiretroviral drugs block various stages in the replication cycle of the virus. There are a growing number of different classes of drug, including:
- Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs), such as zidovudine (AZT), lamivudine (3TC) and tenofovir (TDF).
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as nevirapine, efavirenz, etravirone and delavirdine.
- Protease inhibitors (PIs), such as indinavir, saquinavir, lopinavir and atazanavir.
- Fusion/entry inhibitors, such as maraviroc and enfuvirtide.
- Integrase inhibitors, such as raltegravir.
4. What are the side-effects of ARVs?
Unfortunately there are different side-effects associated with different ARVs, but these vary from person to person. Side-effects can range from mild to severe – nausea, diarrhoea and fatigue are common side-effects that people experience. There are other less common side-effects such as mood fluctuation.
According to Dr van Zyl, Efavirenz causes the most side-effects. Most people experience dizziness, nightmares, sluggishness, and some people even get depressed. These symptoms are short-lived but if they persist please let the doctor or nurse clinician know. There are other options. “We do not want shift workers on Efavirenz because of the drowsiness and dizziness, so do let the doctor or nurse clinician know if you are a shift worker (policeman, doctor, nurse, pilot etc.),” states Dr van Zyl.
5. Can ARVs completely cure HIV/Aids?
No, but they can drastically reduce the viral load in the blood, bringing the virus to a status called “undetectable”, says Dr van Zyl. You however still need to practise safe sex.
6. Can everyone take the same ARVs?
“Most people will start the same first-line regimen, especially in the public health sector,” says Dr van Zyl. The private health sector has different options determined by the treatment prescribed by your doctor.
7. Where can I get ARVs?
ARVs are Schedule 4 drugs, meaning that have to be prescribed by a medical doctor or a nurse clinician who has been trained to manage HIV treatment.
You can get HIV treatment at any public sector health facility in South Africa. If the facility cannot assist you, they will refer you to a facility that can. You can also access treatment via your medical aid.
According to Dr van Zyl, all medical aids in South Africa are obliged to cater for HIV/Aids. The benefits will come from a separate fund for which you do not pay extra. If you are on medical aid, please make sure to ask your scheme how you can be registered on the programme. If you are a cash patient, look for a doctor who is familiar with or who specialises in HIV.