A new tablet for HIV/AIDS

Today, the field of medicine is a vast one and almost all sectors therein are witnessing rapid research and development.

One of the most dreaded diseases in recent years in the medical field which has posed a challenge to nations, R and D organizations and to the field of medicine has been HIV/AIDS. There has been constant research by several organisations, multinationals and even countries who are in a race to find a cure for this disease.  

India is one of the few countries that has a separate institute to work on a cure for this epidemic. On the other hand, the private sector in the United States is leading the research in this field.

A few weeks ago, the US Federal Drug Administration (FDA) approved a new drug to fight HIV/AIDS. The new drug is currently available in the US and it should be in the Indian market any time. This is one of the drugs that are being tested on people diagnosed with HIV/AIDS.

This drug is called Tivicay and it is currently manufactured under licence by GlaxoSmithKline.

It is used to treat the most common strain of HIV, the virus that causes AIDS. It is also known as dolutegravir and it is generic drug. It acts as integrase inhibitors: it blocks the HIV virus from entering cells.
Tivicay, as of now, is owned by ViiV Healthcare, an HIV joint venture between GSK, Pfizer Inc and Shionogi & Co Ltd.
US researchers say Tivicay (50mg) can be used to treat infected adults who have been treated or are being treated with other drugs or are new to treatment.

Tivicay is an integrase strand transfer inhibitor that interferes with one of the enzymes necessary for HIV to multiply. It is a pill taken daily in combination with other antiretroviral drugs.

Researchs in US says Tivicay is approved for use in a broad population of HIV-infected patients. It can be used to treat HIV-infected adults who have never taken HIV therapy (treatment-naïve) and HIV-infected adults who have previously taken HIV therapy (treatment-experienced). This also includes those who have been treated with other integrase strand transfer inhibitors.

Tivicay is also approved for children ages 12 years and older weighing at least 40 kilograms (kg) who are treatment-naïve or treatment-experienced but have not previously taken other integrase strand transfer inhibitors.

It is available as a small, yellow, 50-mg tablet. Importantly, it can be taken with or without food and at any time of the day. Tivicay is now available in pharmacies in the US.

Coming back to the disease, HIV/AIDS occur due to a variety of reasons. It is important for a doctor who treats such patients to zero in on the cause and if you happen to know the cause, you would be doing yourself a favour by revealing it.

In Bangalore, all Government hospitals such as KC General, Bowring and Victoria Hospitals in Bangalore have HIV/AIDS cells. These hospitals have opened Voluntary Counselling and Testing Centres mainly for providing Anti-Retroviral Therapy (ART).

The ART is best understood when you visit one of the centres. By the way, eating nutritious food is an important factor when undergoing ART.

The Karnataka Government has provided certain facilities for HIV/AIDS patients for patients undergoing ART, including subsidized travel and treatment.

The Department of Health and Family Welfare and Karnataka State Aids Prevention Society (KSAPS) first inaugurated this facility in Bangalore. Besides, the Government last year opened  the ID NAT (Individual Donor Nuclic Acid Testing) facility at K C General Hospital in Malleswaram.

Under this scheme, the Government will give 80 paisa per kilometer to HIV+ patients. The patients can reimburse the amount from the government. Patients from urban areas will be paid Rs. 20 to travel one way for ART treatment. In case they spend more than Rs. 20 then the government will reimburse at the rate of 80 paisa per kilometer. A maximum of Rs. 100 will be paid for patients travelling from outside the district  and the procedure of reimbursement will be monitored by a nodal officer.

The ART consists of at least three anti-retroviral drugs to suppress the HIV virus and so far this has been found to be the most effective allopathic treatment. These drugs are being distributed free.

The government also offers treatment for tuberculosis (TB) - one of the deadly opportunistic infections suffered by people living with HIV (PLHIV) and even this is free of cost.

However, free ART and TB medicine do not alone complete HIV treatment. With immunity levels dipping constantly and with new stains being discovered, the infected people need regular and constant medical attention. Besides, recurring infections like herpes and diarrhea could call for regular hospitalisation.

As written earlier, a combination of drugs can be used to control the virus. Each of the classes of anti-HIV drugs blocks the virus in different ways. It is best to combine at least three drugs from two different classes to avoid creating strains of HIV that are immune to single drugs. The classes of anti-HIV drugs include:

Non-nucleoside reverse transcriptase inhibitors (NNRTIs). The NNRTIs disable a protein needed by HIV or virus to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).

Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).

Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).

Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).

Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.

This treatment should begin if you have or are having Your CD4 count under 500: You have HIV-related kidney disease: You're being treated for hepatitis B.

HIV treatment regimens can involve multiple pills at specific times every day. The side effects can include nausea, vomiting or diarrhea, abnormal heartbeats, shortness of breath, skin rash, weakened bones, bone death, particularly in the hip joints.

Please remember that some health issues are a natural part of aging and that they may be more difficult to manage if you have HIV. Some medications that are common for age-related cardiovascular, metabolic and bone conditions, for example, may not interact well with anti-HIV medications. Talk to your doctor, family doctor if you have one, about other conditions you're receiving medication for. There are also known interactions between anti-HIV drugs and:Contraceptives and hormones for women: Medications for the treatment of tuberculosis and Drugs to treat hepatitis C

Once the ART commences, your response is measured by your viral load and CD4 counts. Viral load should be tested at the start of treatment and then at regular intervals-say every three to four months during therapy. CD4 counts should be checked every three to six months.

HIV treatment should reduce your viral load to the point that I becomes undetectable. Mind you, this does not mean that HIV has vanished. It just means that the test is not sensitive enough to detect it or the low levels. Yet, you can still transmit HIV to others when your viral load is undetectable.

In India HIV is most commonly diagnosed by testing your blood or saliva for the presence of antibodies to the virus. Unfortunately, these types of HIV tests are not fully accurate immediately after infection because it takes time for your body to develop these antibodies — usually up to 12 weeks. In rare cases, it can take up to six months for an HIV antibody test to become positive.

A newer type of test checks for HIV antigen, a protein produced by the virus immediately after infection. This test can confirm a diagnosis within days of infection. An earlier diagnosis may prompt people to take extra precautions to prevent transmission of the virus to others. There is also increasing evidence that early treatment may be of benefit.

If you receive a diagnosis of HIV/AIDS, several types of tests can help your doctor determine what stage of the disease you have. These tests include:

CD4 count. CD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV. A healthy person's CD4 count can vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4 count becomes less than 200.

Viral load: This test measures the amount of virus in your blood. Studies have shown that people with higher viral loads generally fare more poorly than do those with a lower viral load.

Drug resistance: This blood test determines whether the strain of HIV you have will be resistant to certain anti-HIV medications and the ones that may work better.

Tests for complications:
Your doctor might also order lab tests to check for other infections or complications, including tuberculosis, hepatitis, toxoplasmosis

Sexually transmitted infections, liver or kidney damage and or

urinary tract infection

In resource-poor nations like India and in the continent of Africa, TB is the most common infection associated with HIV and a leading cause of death among people living with AIDS. Millions of people are currently infected with both HIV and tuberculosis, and many experts consider the two diseases twin epidemics.

Salmonellosis: You contract this bacterial infection from contaminated food or water. Symptoms include severe diarrhea, fever, chills, abdominal pain and, occasionally, vomiting. Although anyone exposed to salmonella bacteria can become sick, salmonellosis is far more common in people who are HIV-positive.

Cytomegalovirus (CMV): This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces — causing damage to your eyes, digestive tract, lungs or other organs.

Candidiasis: Candidiasis is a common HIV-related infection. It causes inflammation and a thick white coating on the mucous membrane of  mouth, tongue, esophagus or vagina. Children may have especially severe symptoms in the mouth or esophagus, which can make eating rather painful and difficult.

Cryptococcal meningitis: Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus that is present in soil. It may also be associated with bird or bat droppings.

Toxoplasmosis: This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasite in their stools, and the parasites may then spread to other animals.

Cryptosporidiosis: This infection is caused by an intestinal parasite that's commonly found in animals. You contract cryptosporidiosis when you ingest contaminated food or water. The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS.

Cancers common to HIV/AIDS

Kaposi's sarcoma: This is a tumor of the blood vessel walls. Although rare in people not infected with HIV, it's common in HIV-positive people. Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs.

Lymphomas: As the name itself suggests, this type of cancer originates in your white blood cells. Lymphomas usually begin in your lymph nodes. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.

Other complications

Wasting syndrome. Aggressive treatment regimens have reduced the number of cases of wasting syndrome, but it does still affect many people with AIDS. It is defined as a loss of at least 10 percent of body weight and is often accompanied by diarrhea, chronic weakness and fever.

Neurological complications. Although AIDS doesn't appear to infect the nerve cells, it can still cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and trouble walking. One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and diminished mental functioning.

Kidney disease: HIV-associated nephropathy (HIV AN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your bloodstream and pass them to your urine. Because of a genetic predisposition, the risk of developing HIV AN is much higher in African Americans. Regardless of CD4 count, anti-retroviral therapy should be started in people diagnosed with HIV AN who are not already being treated.

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection
The majority of people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible symptoms include: fever, muscle soreness, rash

Headache, sore throat, mouth or genital ulcers, swollen lymph glands, mainly on the neck, joint pain, night sweat and diarrhea.

Although the symptoms of primary HIV infection may be mild enough to go unnoticed, the amount of virus in the blood stream (viral load) is particularly high at this time. As a result, HIV infection spreads more efficiently during primary infection than during the next stage of infection.

Clinical latent infection:
In some people, persistent swelling of lymph nodes occurs during clinical latent HIV. Otherwise, there are no specific signs and symptoms. HIV remains in the body, however, as free virus and in infected white blood cells.

Clinical latent infection typically lasts eight to 10 years. A few people stay in this stage even longer, but others progress to more-severe disease much sooner.

Coming back to AIDS in India, the country has seen a 57 percent drop in number of new HIV infections during the last decade and these are the latest figures from the National AIDS Control Organisation (NACO).
India has seen reduction of new Human immunodeficiency virus (HIV) infections (among adult population) from 2.74 lakh in 2000 to 1.16 lakh in 2011.
NACO says nearly 1.5 lakh lives have been saved due to free Anti-retroviral Therapy (ART) medicines provided to HIV/AIDS patients. But these figures are nothing to crow about when you remember that the first case of HIV/AIDS was reported in India in 1986.

(These facts are compiled from several medical and pharmacy reports and also bulletins and journals. The information here is meant only to help guide people and all drugs and medication should only be taken with doctors’ prescription. The facts here are only for purposes of reference and not for any other purpose).