Diagnosis and treatment

Diagnosis

Like with many other diseases, early diagnosis is key to good long-term health and survival. People in the UK living with HIV can expect a near normal life expectancy, particularly if they are diagnosed early. Explore the graphic below to see four key points about the importance and benefits of an early HIV diagnosis and how it compares to outcomes when the diagnosis is delayed.

Treatment options

Early treatment saves lives. It can prevent HIV from ever advancing to AIDS, allowing people to live healthy and long lives. Early drug treatment dramatically reduces the risk the virus will be passed to an uninfected sexual partner. In fact, a recent US government-funded study showed that the use of antiretroviral therapy cut infection rates by 96% (National Institute of Health, 2011).

Immediate treatment

If you, a patient, client, or colleague believe you have been exposed to HIV, anti-HIV medication called PEP (post-exposure prophylaxis) may help stop infection from occurring. If possible exposure to HIV is a result of a sexual encounter, such as from a condom accident or unprotected sex, or a sexual assault, the treatment is called post-exposure prophylaxis after sexual exposure (PEPSE). PEP is a course of medication that can prevent HIV infection by stopping the virus from reproducing before it has a chance to get established. For PEP to be effective it needs to be started within 72 hours (three days) of exposure. The sooner after exposure it is started the better- it is unlikely to work if it is started after the 72 hours and won’t usually be prescribed after that time. PEP is sometimes called ‘the morning-after pill for HIV’ but this is a misnomer. PEP is taken daily over the course of one month and isn’t always effective. It also can cause side effects, some of which can be severe.

PEP is available from sexual health clinics, hospital accident and emergency departments, and many occupational health departments. It is not generally available at GP surgeries; however, some GP surgeries and community hospitals do provide PEP, but only for cases involving occupational exposure. And while it is often very effective, it doesn’t always work - it reduces the risk of infection, but doesn’t eliminate it. It’s important, then, that PEP isn’t thought of as a cure for HIV or encourages someone to adopt risky practices in the mistaken belief that a course of PEP will remove any risk.

Longer-term treatment

HIV is now a long-term health condition that with early diagnosis and treatment can be managed much like other chronic health conditions. HIV is treated with antiretroviral (ARV) drugs which slow the reproduction and spread of the virus. People usually take a combination of three or more ARV medications (called combination therapy or highly active anti-retroviral therapy) because the virus is quick to adapt and become resistant to a single ARV. Most people with HIV will continue to take the medication for the rest of their lives. The drugs will reduce the amount of HIV in their body, but won’t make it disappear entirely. As with any medication, ARVs need to be checked for possible contraindication with other medications.

Treating the older patient: HIV and aging

HIV can mistakenly be thought of as a young person’s disease. But this is a fallacy — older people are the fastest growing group in the UK with HIV, and their numbers are expected to continue to grow. Why? First, better drug therapies mean people with HIV are living longer. Today, more than 1 in 5 adults in the UK accessing HIV care is over the age of 50. But this isn’t the only reason for the increase — there are more new transmissions for people of this age than ever before. In the UK, since 2000 the number of new HIV diagnoses in this population has almost tripled. The reasons for this include older people enjoying new sexual relationships as long-term relationships end and the availability of erectile dysfunction drugs, such as Viagra, allowing for more active sex lives later in life. This population has unique issues and concerns, one of which is the high number of late diagnoses. Nearly two-thirds (62%) of older adults were diagnosed late, when their immune systems were already compromised. Select the interactive areas in the activity below which identifies four other issues faced by people in this group and four suggestions for how you can support them.