Anti-retroviral (ARV) drugs have the potential to dramatically improve the health and extend the lives of people with HIV/Aids. Anti-retroviral treatment (ART) is a combination of medicines that are given to someone who is sick with Aids. Their administration to the patient deserves a careful hand. ARVs fight HIV in the body though ART is not a cure for AIDS. Once well administered, the drugs help to make the patient’s immune system stronger so that you can be healthier. It also helps your body to fight off and prevent illnesses such as pneumonia, tuberculosis (TB) and diarrhea. Why it is Important: Effective HIV/Aids care requires anti-retroviral therapy as a treatment option. Without access to anti-retroviral therapy, people living with HIV/Aids cannot attain the fullest possible physical and mental health and cannot play their fullest role as actors in the fight against the epidemic, because their life expectancy will be too short. How it works Selection of ARV treatment procedures for programmes and individual patients should consider: potency, frequency of dosage, side effects, maintenance of future treatment options, anticipated adherence of the patient population to the procedure, need for storage, concurrent conditions, the potential for resistant viral strains and the cost and access. Additional considerations may include access to only a limited number of ARV drugs, limited health service infrastructure, the need to deliver drugs to rural areas, a high incidence of tuberculosis and hepatitis B and/or C, and the presence of varied HIV groups and subtypes. The World Health Organization (WHO) recommends that during ARV treatment programmes, infected adolescents and adults should start ARV therapy after undergoing clinical AIDS tests regardless of CD4 count. When the CD4 count is available, all HIV infected people with less than 200 CD4 cells/mm3 should be offered ARV treatment. Clinical assessment prior to the initiation of ART includes documentation of past medical history, identification of current and past HIV related illnesses, identification of co-existing medical conditions and medications in use that may influence choice of therapy (such as TB or pregnancy) as well as current symptoms and physical signs. Minimum laboratory tests include an HIV antibody test, and (if ZDV is part of the regimen) haemoglobin or hematocrit levels. Highly desirable tests are white blood cell count and differential CD4 count, serum alanine, aspartate aminotransferase levels, serum creatinine, blood urea nitrogen, serum glucose, bilirubin, amylase and serum lipids, and pregnancy tests for women. Toxicity should be monitored clinically based on patient reports and physical examination. This can be supplemented by a limited number of laboratory tests depending on the symptoms that arise and the specific combination procedure that is used. How will one know whether the ARVs will work? A health worker will check whether the ARV medicines are working well for you by carrying out the following: A CD4-cell count: This test checks the number of your CD4 cells. If the ARV medicines are working well, you will have more CD4 cells to fight infection in your body. This is a sign that your immune system is getting stronger. If your CD4-cell count is less than 50, it may not go up very much in the beginning, but you will still feel better. NOTE: CD4+ cell is an immune system cell which plays a key role in orchestrating the way the immune system attacks foreign invaders. HIV infection leads to the destruction of these cells, leaving the immune system less able to fight infection. A normal CD4+ count in a healthy, HIV negative adult is usually between 600 and 1200 per cubic millimetre of blood. In an Aids patient it is usually below 200. A viral load test: This test checks if your viral load is going down until there is so little HIV in the blood that the test cant find any virus. If the ARV medicines are working well, this can happen in about 12 weeks. Remember, ARVs cannot cure or remove HIV from the body completely even if the blood test shows that there is no virus. If you stop taking ARVs, the virus will start to increase again in the blood. Examination: A health worker will examine you to check your weight and to see if there are any changes in your body and your health. Learn about the side-effects of ARVs: If you do have side-effects, they can be very difficult to get used to and to cope with. You may worry about what is happening to your body when they arise. People will have side-effects in different ways. If you have a low CD4-cell count and weak immune system, you will probably have more side-effects than someone who is healthy. One way to prepare you to cope with side-effects is to learn more about them. Join or form a support group with other people on ART and discuss ways to deal with your side-effects. Some side-effects may be serious. They may be a sign that the ARV medicines are not working or are causing serious damage to the body. The health worker should tell you what to watch out for and what to do. Do not stop taking your medicines. Talk to your health worker, if you find it hard to cope with side-effects such a person will be in position to advise you accordingly. Ends
