HIV Information Booklet

The information in this booklet is designed to help you understand and manage HIV infection. It is not intended as medical advice. All persons with HIV should consult a health-care professional for diagnosis and treatment.

Introduction

The human immunodeficiency virus (HIV) is a blood-borne organism that is associated with acquired immunodeficiency syndrome (AIDS). The first cases of what we now call AIDS were reported in 1981, and the virus was identified in 1983. (Note: HIV-1, the type most often seen in the U.S., is discussed in this booklet; HIV-2, a related virus, is common in West Africa but rare in the U.S.)

Although statistics vary widely, the U.S. government estimates that between three-quarters of a million and 1 million people in the U.S. are infected with HIV and some 350,000 are living with AIDS. An estimated 40,000 people are newly infected with HIV each year. In the U.S., about two-thirds of people with AIDS are men, especially men who have sex with men, and the disease is more common in African Americans and Latinos than in whites. Worldwide, it is estimated that some 40 million people have HIV or AIDS.

The occurrence of deaths due to AIDS in developed countries has decreased dramatically in recent years due to the widespread use of effective new drugs and combination regimens. AIDS activists have played a key role in pushing for more research, faster drug approval, and better services for people with HIV. Today, much emphasis is placed on preventing new infections, dealing with the serious side effects of HIV therapies, and making treatments available to people in poor countries.

How Common is HIV/AIDS?

• Estimated number in U.S. infected with HIV: 900,000
• Estimated number in U.S. living with AIDS: 350,000
• Estimated number of new annual HIV infections in U.S.: 40,000
• Estimated number of AIDS/HIV cases worldwide: 40,000,000
• Estimated number of new annual HIV infections worldwide: 5,000,000

HIV Transmission and Prevention

HIV is a blood-borne virus that is transmitted through infected blood, semen, vaginal secretions, and breast milk. To enter the body, the virus must come into direct contact with the bloodstream, with a mucous membrane, or with broken skin. HIV is most often transmitted through sexual contact and shared needles.

Anal and vaginal intercourse are known to efficiently transmit HIV. Oral sex on a man has a much lower transmission rate. Other types of sexual activity such as oral sex on a woman or manual contact with the genitals are very unlikely to transmit the virus. The presence of other sexually transmitted infections such as syphilis, gonorrhea, or genital herpes increases the risk of sexual transmission of HIV. HIV-infected people with no symptoms can still transmit the virus.

Many people have contracted HIV through sharing needles, syringes, and other "works" to inject drugs. Needles used for tattooing and body piercing are also a possible transmission route. Health-care workers may contract HIV through needle-sticks or other accidental exposures on the job. Many people contracted HIV through blood transfusions before the HIV antibody test was developed in 1985; today donated blood is tested and heat-treated and is considered safe.

HIV can also be transmitted from mother to child during pregnancy or birth (vertical or perinatal transmission) or through breast-feeding. Vertical transmission is more likely if the mother has a high viral load. Use of antiretroviral drugs such as AZT or nevirpine can reduce the risk of vertical transmission from about 25% to about 5% or less. In the U.S. and other developed countries it is recommended that women with HIV should not breast-feed their babies.

There is no evidence that HIV is transmitted through saliva, sweat, tears, or urine, and the virus cannot live long outside the human body. HIV is not transmitted through casual or household contact including hugging or kissing, coughing or sneezing, or sharing eating utensils or drinking glasses.

There is currently no vaccine to prevent HIV, although much research in this area is underway. If a person has been exposed to HIV, they may be eligible for post-exposure prophylaxis (PEP). PEP involves starting anti-HIV drugs within 72 hours of exposure. It is not known whether PEP can help prevent or reduce the severity of HIV disease in people exposed through sex or needle sharing, but it has shown benefits in health-care workers accidentally exposed on the job.

HIV Prevention Guidelines

• Do not share needles or other equipment to inject drugs; obtain new needles from a needle exchange or-if you must share- clean needles and syringes thoroughly with bleach.
• Practice safer sex, including the consistent use of latex condoms and barriers with water-based lubricants; avoid products that contain nonoxynol-9.
• Tattooists, piercers, and acupuncturists should use new needles for each client.
• Do not share personal items such as razors or toothbrushes.
• Exercise universal precautions in health-care settings, including use of latex gloves.
• Properly dispose of used needles, bandages, and menstrual supplies; clean and disinfect spilled body fluids.

HIV Disease Progression

Many people with primary or acute (early) HIV infection have no symptoms. Others may experience an "acute retroviral syndrome" characterized by fever, fatigue, headache, and enlarged lymph nodes. These symptoms usually disappear within a week to a month, and can be easy to mistake for a bout of the flu. During this initial period HIV is believed to be very easy to transmit.

After HIV enters the body, it infects various types of cells, primarily targeting a type of immune system cell called CD4 cells. These cells-also called T-helper cells-play an important role in coordinating the body's immune defenses. HIV enters CD4 cells and uses the cell's machinery to produce new viral particles (virions), eventually killing the host cell.

HIV disease progresses slowly, and people with HIV may be asymptomatic (without symptoms) for ten years or longer. Infants and children infected with HIV tend to become ill sooner. As more and more CD4 cells die, immune function is reduced and the body is less able to fight infections and cancers. As this happens, people may develop symptoms such as swollen lymph nodes, fever, fatigue, and weight loss. These early symptoms may come and go. A minority of people do not develop symptoms even without treatment.

Some HIV/AIDS Symptoms

• Swollen lymph nodes
• Fever; night sweats
• Fatigue
• Headache
• Nausea
• Diarrhea
• Loss of appetite
• Weight loss; wasting
• Skin rashes; red or purple blotches on skin
• Thrush; vaginal yeast infections; fungal nail infection
• Mental impairment; memory loss

AIDS is the advanced stage of HIV disease. Once the CD4 count falls below 200-and especially if it drops below 50-people become susceptible to a variety of opportunistic illnesses (OIs). These are infections or cancers that usually do not cause symptoms in healthy people, but may cause serious illness in people with compromised immune systems. There are over twenty AIDS-defining conditions. HIV positive people with CD4 cell counts below 200 are classified as having AIDS even if they do not have OIs. The classic symptoms of AIDS-such as persistent diarrhea, night sweats, wasting, skin conditions, and mental impairment­-are usually due to OIs. (However, as describe below, the drugs used to treat HIV can themselves cause side effects such as nausea, diarrhea, and skin rash.) Children with HIV may experience delayed development or "failure to thrive." Diseases such as cervical cancer, hepatitis C, herpes, and tuberculosis may be much more aggressive in people with HIV, and are considered AIDS-related illnesses even though they also occur in people without HIV.

In recent years the incidence of OIs has fallen due to improved anti-HIV treatments. Effective treatment can keep HIV under control and help prevent the loss of CD4 cells. With appropriate treatment, some people may be able to hold off late-stage disease and the development of OIs indefinitely.

Some AIDS-Related Opportunistic Illnesses

• Candidiasis (thrush, yeast infection): a fungal infection characterized by white patches in the mouth, difficulty swallowing, and in women, vaginal irritation and thick, white discharge.
• Cytomegalovirus (CMV): a virus that can infect the retina of the eye (vision loss), the large intestine (diarrhea), the throat (painful swallowing), the lungs (pneumonia), and the brain (confusion and altered mental state).
• Cryptococcal meningitis: a fungal infection of the brain characterized by severe headaches, altered mental state, and possibly seizures.
• Cryptosporidiosis: a parasite, often spread through contaminated water, that can cause nausea, severe diarrhea, and wasting.
• Histoplasmosis: a fungal infection that can cause fever, fatigue, weight loss, and difficulty breathing.
• Kaposi's sarcoma: a cancer characterized by red or purple blotches on the skin or mucous membranes; may also affect internal organs.
• Lymphoma: a cancer of the lymphatic system that may affect the lymph nodes, brain, or gastrointestinal tract; symptoms include swollen lymph nodes, fever, fatigue, and weight loss.
• Mycobacterium avium complex (MAC): a bacterial infection characterized by fever, night sweats, fatigue, diarrhea, and weight loss.
• Pneumocystis carinii pneumonia (PCP): a parasite that infects the lungs, causing fever, dry cough, shortness of breath.
• Toxoplasmosis: a parasite that infects the brain, causing fever, severe headaches, altered mental state, seizures, and coma.

HIV Diagnosis and Monitoring

Antibody Tests

Two tests are commonly used to detect HIV infection. The ELISA test measures antibodies against HIV. If this test is positive, a second confirming test called a Western blot is done. Usually a blood sample is taken, but the newer Orasure test uses oral fluid from a test pad inserted in the mouth. Anonymous testing (in which your name is not taken) is available in some areas; elsewhere, HIV testing is confidential. There are also home HIV test kits. Some states require that HIV infections and AIDS cases be reported to health officials. There is a six-week to six-month "window period" after a person is infected before the body develops enough antibodies to be detected (seroconversion). Babies born to HIV positive women carry their mothers' antibodies against the virus for several months even if they are not themselves infected.

Viral Load and CD4 Count

Viral load tests measure actual HIV RNA (genetic material) in the blood. They can detect infection sooner than antibody tests; however, they are not approved for HIV diagnosis. Two types of viral load test-polymerase chain reaction (PCR) and branched-chain DNA (bDNA)-are commonly used to measure the amount of HIV in the blood. The presence of detectable HIV RNA means the virus is actively replicating (reproducing). Viral load tests are usually reported as number of copies of HIV RNA per milliliter of blood. Changes in viral load may be reported in terms of logs (factors of ten).

The CD4 cell count is measured to assess the health of the immune system. A normal CD4 cell count is 500-1200. CD4 cell percentage and CD4/CD8 cell ratio are also sometimes measured. If the CD4 count falls below 200, a person is more likely to develop opportunistic illnesses.

People with HIV should have their viral loads and CD4 cell counts measured regularly, every 3-6 months. These tests help doctors decide whether treatment is necessary and can indicate whether HIV disease is progressing and whether treatment is working. With both CD4 cell count and viral load, a single measurement is not as useful as the trend in test results over time.

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HIV Treatment

HIV treatment has undergone remarkable improvements in the past five years, and the rate of opportunistic illness and death due to AIDS has been greatly reduced. However, the novel treatment regimens are increasingly associated with new and potentially life-threatening side effects.

Approved Drugs

The standard therapy for HIV disease is a combination "cocktail" of at least three antiretroviral drugs. Anti-HIV medications must be used in combination regimens because use of a single drug (monotherapy) can lead to the development of drug-resistant virus mutations. The most successful regimens, combining drugs from different classes, are known as highly active antiretroviral therapy (HAART). The anti-HIV medications currently approved by the Food and Drug Administration fall into three classes:

• Nucleoside reverse transcriptase inhibitors (NRTIs), also called nucleoside analogs, and nucleotide analogs: these drugs interfere with HIV replication by acting as defective genetic building blocks. Nucleoside analogs include abacavir (Ziagen), AZT (Retrovir), ddC (Hivid), ddI (Videx), d4T (Zerit), and 3TC (Epivir). Combivir is AZT plus 3TC combined in a single pill, and Trizivir is AZT plus 3TC plus abacavir in a single pill. Nucleotide analogs are similar, but require one less processing step in the body. There is only one approved nucleotide analog for HIV, tenofovir (Viread).
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): these drugs inhibit HIV replication by binding with the virus' reverse transcriptase enzyme. They include delavirdine (Rescriptor), efavirenz (Sustiva), and nevirapine (Viramune).
• Protease Inhibitors (PIs): these drugs interfere with HIV's protease enzyme and prevent the assembly of new virus particles. They include amprenavir (Agenerase), indinavir (Crixivan), lopinavir (Kaletra), nelfinavir (Viracept), ritonovir (Norvir), and saquinavir (Fortovase or Invirase).

Treatment Considerations

HIV treatment is designed to reduce HIV replication, thus preventing infection of additional CD4 cells. The most successful treatment regimens reduce HIV RNA to undetectable levels. There is currently no cure for HIV, and the virus cannot be eradicated-in part because it can hide in various "reservoir" sites such as the brain and lymph nodes.

When to start antiretroviral treatment is controversial. Some practitioners favor starting therapy soon after testing HIV positive, in the hopes that this will preserve immune system function. Others prefer to wait in order to avoid drug side effects and to hold off drug resistance as long as possible. Growing concern about the adverse effects of anti-HIV medications recently led a panel of experts to take a more cautious approach, revising the federal government's guidelines to suggest starting HIV treatment when the CD4 cell count falls below 350 (rather than 500 in previous guidelines) and viral load is above 55,000 copies (rather than 10,000 copies).

There is also no definitive answer about which drugs to start with. The usual recommendation is to begin with a protease inhibitor plus two NRTIs. However, in some cases it is appropriate to add an NNRTI or to substitute an NNRTI for a protease inhibitor. And for some people, three NRTIs seems to be the best regimen.

Treatment does not always succeed in reducing HIV viral load to an undetectable level. "Treatment failure" usually occurs when HIV mutates to become resistant to a drug. This may happen if people do not take every dose of their drugs as prescribed. Adhering to HIV therapy can be difficult because multiple drugs often must be taken throughout the day, sometimes with specific food restrictions. Fortunately, new combination pills and drugs that can be taken fewer times per day have recently been developed. Also, there are now genotypic and phenotypic resistance tests that can detect drug resistance mutations and help doctors determine which drugs are likely to work best.

People who experience treatment failure may switch to new regimens or have additional drugs added to an existing regimen. Some people-especially those who have been HIV positive for a long time and have tried many different drugs-may require "salvage therapy" with six or seven medications or with experimental drugs. Some recent research suggests that HIV treatment may be beneficial even if viral load does not become undetectable.

Because anti-HIV drugs can potentially interact with each other, with drugs for other conditions, and with certain herbs and foods, HIV treatment can be very complex. Studies have shown that patients do best when their doctor has had experience in treating HIV. Therapy for HIV is evolving rapidly, and the federal government frequently updates its treatment guidelines based on the latest research; for the most recent guidelines visit www.hivatis.org.

OI Prevention and Treatment

Due to improvements in HIV therapy, opportunistic illnesses caused by infectious organisms are much less common than they were earlier in the epidemic. Because such illness typically do not occur until CD4 cells fall to a low level, today they are most often seen in people who are not receiving HIV treatment-and who may not even know they have HIV until they develop OI symptoms. Before the era of HAART, people with HIV often took various drugs to prevent new or recurring OIs (prophylaxis). With successful HIV treatment that raises CD4 cell counts above 200, many people have been able to stop OI prophylaxis. Still, preventive drugs and maintenance therapy are often indicated if CD4 cell counts fall below 200. Some OI prevention and treatment drugs include:

• For cytomegalovirus: for people with CD4 cell counts below 50, prophylaxis with oral ganciclovir; treatments may include cidofovir (Vistide), foscarnet (Foscavir), ganciclovir (Cytovene), and/or valaganciclovir (Valtrex).
• For fungal OIs: treatments may include ampotericin B (Amphocin), fluconazole (Diflucan), and/or itraconazole (Sporanox).
• For Mycobacterium avium complex: for people with CD4 cell counts below 50, prophylaxis with azithromycin (Zithromax), clarithromycin (Biaxin), or rifabutin (Mycobutin); treatments may include azithromycin, clarithromycin, ethambutol, and/or ribafutin.
• For Pneumocystis carinii pneumonia (PCP): for people with CD4 cell counts below 200, prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMX, Bactrim or Septra) or aerosolized pentamidine; treatments may include TMP/SMX, atovaquone (Mepron), dapsone, and/or intravenous pentamidine.
• For toxoplasmosis: for people with CD4 cell counts below 100, prophylaxis with TMP/SMX; treatments may include clindamycin (Cleocin), sulfadiazine, and/or pyramethamine (Daraprim).

The medications above are by no means a complete list. For the most recent federal guidelines for OI prevention and treatment, visit www.hivatis.org. Inform your health-care provider promptly if you experience any new or unusual symptoms that could signal an opportunistic illness.

Drug Side Effects

Antiretroviral and OI medications are associated with numerous side effects including nausea, diarrhea, and low red or white blood cell counts. NRTI drugs are associated with peripheral neuropathy (nerve damage) and mitochondrial toxicity, which affects tiny energy-producing organelles inside cells. One NRTI, abacavir, is associated with a potentially life threatening hypersensitivity reaction in about 5% of people; anyone who experiences fever, skin rash, vomiting, abdominal pain, muscle aches, and/or shortness of breath should stop taking abacavir and not start it again.

Since HAART came to be widely used in the late 1990s, many people with HIV have experienced new and unusual metabolic symptoms. These include body fat redistribution (lipodystrophy), characterized by loss of fat in the face and limbs and accumulation of fat in the abdomen, breasts, or back of the neck. Many people develop insulin resistance and high levels of fats-especially cholesterol and triglycerides-in the blood (hyperlipidemia). Very high triglyceride levels can lead to pancreatitis (inflammation of the pancreas). There is increasing concern that high blood fat levels may lead to increased risk of heart disease. People may also experience bone loss (osteopenia or osteoporosis), which can lead to easy fracturing. Although these different symptoms appear to be most closely associated with protease inhibitors, it is still not known for sure whether they are due to drugs, long-term infection with HIV, immune system recovery, or some other unknown factors.

Antiretroviral drugs are metabolized by the liver, and many can cause liver toxicity (hepatotoxicity); this is especially the case with the older protease inhibitors such as ritonavir. Liver toxicity is most likely to occur in people with existing liver damage, including those with chronic hepatitis C or B. Drug interactions can lead to slower or more rapid processing, which can either increase the side effects or reduce the effectiveness of various medications.

Many people find that side effects are worse when they first start taking a new drug, but diminish over time. In other cases, lower doses or different drugs may be needed. Doctors are increasingly using adjunct drugs, such as statins, to manage high blood fat levels. Some patients find that complementary therapies help to control side effects.

Researchers are experimenting with new drugs, new combinations, and new dosing schedules to try to reduce the adverse effects of anti-HIV drugs. Because protease inhibitors are most closely associated with metabolic side effects, there is growing interest in "protease sparing" regimens. There is also increased research on structured treatment interruptions or structured intermittent therapy, which involves alternating cycles on and off drugs under careful medical supervision.

People being treated for HIV should be regularly monitored for side effects. This should include liver function tests, blood cell counts, and blood fat levels. Inform your doctor about any new symptoms or worsening of existing symptoms, and talk to your health-care providers about ways to manage treatment side effects.

Experimental Drugs

Many new drugs for HIV are being developed and tested. New combination pills and once-daily regimens should make it easier for people to adhere to their therapy. Several new drugs being developed in the major existing classes. But the most promising experimental candidates are those that work by different mechanisms than existing approved drugs. The hope is that these new drugs can be used in combination with existing drug classes to attack HIV on multiple fronts and prevent the development of resistance. New anti-HIV drugs currently under study include:

• Nucleoside reverse transcriptase inhibitors (NRTIs): new candidates include amdoxovir and emtricitabine (Coviracil)
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): new candidates include capravirine, TMC-125, DPC-083, and calanolide A.
• Protease Inhibitors (PIs): new candidates include atazanavir (Zrivada), mozenavir, tipravavir, and TMC-114.
• Entry inhibitors: these drugs prevent HIV from fusing with and entering a host cell; they include T-20 (enfuvirtide or Fuzeon) and T-1249.
• Integrase inhibitors: these drugs interfere with the ability of HIV to insert its genes into a host cell's DNA; they include AR-177 (Zintevir) and S-1360.
• Chemokine receptor antagonists: these drugs work by preventing HIV from binding with chemokine receptors (CCR5 or CXCR4) on a host cell's surface, thus inhibiting viral entry into the cell.
• Zinc finger inhibitors: these drugs disrupt HIV replication by interfering with the insertion of HIV genetic material into new virus particles. Candidates include azodicarbonamide.
• Immune-based therapies (immunomodulators): these are intended to boost the immune system, helping the body to fight HIV; therapeutic vaccines are one type of immune-based therapy.

Clinical Trials

The process of testing a new drug candidate involves establishing its safety and tolerability (Phase I trials), measuring its effectiveness (Phase II trials), and comparing the new drug to current standard treatments (Phase III trials). After the Food and Drug Administration (FDA) has granted approval and the new drug is marketed, ongoing studies are done to refine the treatment and detect less common and long-term side effects (Phase IV, or post-marketing trials). Clinical trials can be a good way to obtain free medication; some trials also may cover the costs of laboratory tests. Be aware that clinical trial participants typically are randomized to receive either the experimental drug or the existing standard treatment; you may not be chosen to receive the new drug or the most effective dosage. Read all the clinical trial information and make sure that you fully understand the terms and conditions before you give your informed consent to participate.

Alternative Therapies

In addition to antiretroviral and OI drugs, many people with HIV use various alternative and complementary therapies including herbal remedies, traditional Chinese medicine, and nutritional supplements. Some find that such therapies help manage side effects due to pharmaceutical drugs. As alternative therapies becoming increasingly popular, more are being tested using Western-style clinical trials, but to date there is little information about the use of most such treatments in people with HIV. Carefully research any treatments you are considering, and consult trained and experienced practitioners such as herbalists or nutritionists. Herbal remedies should be treated like drugs, since they may have side effects and can interact with conventional medications; several herbs are known to interact with anti-HIV drugs. Be sure to inform all your health-care providers about any herbs, supplements, or other alternative therapies you are using.

HIV/HCV and HIV/HBV Coinfection

Coinfection occurs when a person is infected with two or more different disease-causing organisms. Because HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) are all blood-borne infections that are transmitted in some similar ways, many people are coinfected with HIV/HCV or HIV/HBV. Coinfection is an increasingly important public health issue, and the U.S. Public Health Service and Infectious Diseases Society of America recommend that all people with HIV should be tested for HCV. HIV/HCV and HIV/HBV coinfection are poorly understood and more research is needed on how these diseases interact. HIV appears to accelerate HCV disease progression, but HCV does not seem to make HIV more aggressive. Many drugs used to treat HIV and OIs can be toxic to the liver, and liver damage due to chronic hepatitis C or hepatitis B can complicate HIV treatment. However, most people with HIV/HCV or HIV/HBV coinfection can be treated for both diseases.

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Taking Care of Yourself

Medical Care

HIV is a difficult disease to manage. People with HIV should receive regular medical care, preferably by a specialist with experience in treating HIV. Viral load and CD4 cell count should be measured every 3-6 months to help determine whether treatment is working. Liver function tests, blood cell counts, and blood fat levels should also be measured regularly to detect side effects. Some people may need more frequent monitoring, especially when they are starting new antiretroviral drugs.

Health Tips

• Get regular health check-ups
• Have viral load, CD4 cell count, liver function tests, and blood fat levels monitored regularly
• Inform health-care providers about all drugs, herbs, supplements, and alternative therapies you are using.
• Eat a healthy, well-balanced diet.
• Get regular, moderate exercise.

Nutrition

Good nutrition is important and can help maintain the health of the immune system. A healthy diet should follow the general guidelines based on the Food Guide Pyramid. Such a diet is low in fat and sodium, high in complex carbohydrates, and has adequate protein. Many people with HIV experience appetite loss and wasting, and may require high-calorie nutritional supplements. People who develop high blood fat levels related to HIV treatment may need to modify their diets to cut back on fat. Read labels and become familiar with ingredients in foods. Consult a licensed dietitian for specific dietary recommendations and seek medical advice before undertaking any unconventional diet.

Exercise

Regular aerobic exercise can improve overall fitness and may help reduce fatigue, stress, and depression. Lifting weights can help prevent muscle wasting. Most people with HIV can safely engage in moderate exercise, but avoid exercise if you are feeling very ill. Consult your health-care provider before starting an exercise program.

Managing Stress and Fatigue

Controlling stress is a major factor in managing HIV disease. Exercise, meditation, and time management can all help reduce stress. Many people find that meditation (a method of relaxation and clearing and focusing the mind) reduces stress and helps them maintain a healthy outlook on life. Fatigue and low energy levels are common in people with HIV. Learn your limits and try not to overextend yourself. Plan activities in advance and try to make realistic work and play schedules. Take naps as needed and get enough sleep at night. Try to maintain a realistic picture of your health and a positive attitude.

Support Groups and Other Resources

Many people with HIV feel isolated and find it difficult to cope with living with a chronic illness. A support group can offer a safe space to discuss the emotional issues surrounding HIV. In addition, information shared by peers can be helpful in making treatment decisions, managing symptoms and drug side effects, and developing coping strategies. Some people also find therapy with a trained psychologist or social worker to be beneficial.

In addition, you may find counseling about employment, disability benefits, and legal issues to be helpful. All states have AIDS Drug Assistance Programs (ADAPs) that help pay for antiretroviral and OI drugs for people who cannot afford them. In some areas programs that provide housing and substance abuse treatment for people with AIDS are also available.

The Internet

The Internet contains a wealth of information-both good and bad. Always check the sources of the information you find online. Look for dates and references. Be skeptical of web sites that use the word "cure." Remember that not all the information you find on the Internet is correct. Talk to your health-care provider about any information you are concerned about. Some useful web sites are listed below. Common sense can go a long way!

Conclusion

Living with HIV can be challenging. While HIV disease remains life-threatening and there is no cure, new treatments have improved the health of many people with HIV and have greatly reduced the risk of death due to AIDS. HIV disease progresses slowly, and many people with HIV can go for years without experiencing symptoms. With appropriate treatment, it may be possible to prevent opportunistic illnesses indefinitely. However, current anti-HIV drugs can have serious side effects. Fortunately, new drugs are continually being developed and research is helping refine treatment strategies. It is important to work as a team with your doctor and other health-care providers, receiving regular monitoring and informing them of any changes in your symptoms. In addition to medical treatment, good nutrition, exercise, and stress management can all help improve the quality of life for people with HIV.

We hope this information has helped you to understand HIV and how it can affect your health. We welcome any suggestions or ideas for improving this brochure.  

HIV Resources

• HIV/AIDS Treatment Information Service (includes latest U.S. government HIV treatment guidelines): www.hivatis.org
• AIDS Clinical Trials Information Service: www.actis.org
• AIDS Education Global Information System: www.aegis.comwww.aegis.com
• The Body: www.thebody.com
• CDC Division of HIV/AIDS Prevention: www.cdc.gov/hiv/dhap.htm
• HIV and Hepatitis: www.hivandhepatitis.com
• HIV InSite (University of California at San Francisco): www.hivinsite.com
• Project Inform: www.projectinform.org; hotline: 800-822-7422
• San Francisco AIDS Foundation (site includes Bulletin of Experimental Treatments for AIDS magazine): http://www.sfaf.org; hotline: 800-367-2437
• Gay Men's Health Crisis (site includes Treatment Issues magazine): www.gmhc.org.

The Hepatitis C Support Project

This information is provided by the Hepatitis C Support Project. The mission of the project is to offer support to those affected by HCV. The project provides information, education, and support groups, and seeks to serve the HCV community as well as the general public.

Hepatitis C Support Project
PO Box 427037
San Francisco, CA 94142


Executive Director
Editor-in-Chief, HCSP publications Alan Franciscus

Medical Writer
Liz Highleyman

Copyright - October 2002 - The Hepatitis C Support Project. www.hcvadvocate.org. Reprint permission is granted and encouraged with credit to the Hepatitis C Support Project

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