There is no cure for HIV, but treatments are much more successful than they used to be, enabling people with the virus to stay healthy and live longer.
Emergency HIV drugs
If you think you have been exposed to the virus within the last 72 hours (three days), anti-HIV medication may stop you becoming infected.
For it to be effective, the medication, called post-exposure prophylaxis or PEP, must be started within 72 hours of coming into contact with the virus.
The quicker PEP is started the better, ideally within hours of coming into contact with HIV. The longer the wait, the less chance of it being effective.
PEP has been misleadingly popularised as a “morning-after pill” for HIV – a reference to the emergency pill women can take to prevent getting pregnant.
But the description is not accurate. PEP is a month-long treatment, which has serious side effects and is not guaranteed to work. The treatment involves taking the same drugs prescribed to people who have tested positive for HIV.
You may be able to get PEP from:
- sexual health clinics, or genitourinary medicine (GUM) clinics
- hospitals – usually accident and emergency (A&E) departments
- if you already have HIV, try your HIV clinic if the PEP is for someone you’ve had sex with
Not all these places in every part of the country will have PEP or be able to give it. GPs usually do not provide PEP.
Want to know more?
- Terrence Higgins Trust: post-exposure prophylaxis (PEP)
If you test positive
If you are diagnosed with HIV, you will have regular blood tests to monitor the progress of the virus before starting treatment.
You will not normally need to start treatment until the virus has begun weakening your immune system.
This is determined by mainly by measuring your levels of CD4, which are infection-fighting cells, in your blood.
Treatment is usually recommended to begin when your CD4 count falls to 350 or below, whether or not you have any symptoms. Treatment is also recommended to as soon as possible if your CD4 count is getting close to 350.
The aim of the treatment is to reduce the level of HIV in the blood and prevent or delay any HIV-related illnesses.
Want to know more?
- namlife: Why monitor CD4 and viral load?
- namlife: When to start treatment?
If you have another condition
If you have also been diagnosed with hepatitis B or hepatitis C, it is recommended that you start treatment when your CD4 count falls below 500.
Treatment is recommended to begin at any CD4 count if you are on radiotherapy or chemotherapy that will suppress your immune system, or if you have been diagnosed with certain other illnesses, including:
- tuberculosis
- HIV-related nephropathy (kidney
disease) - HIV-related neurocognitive (brain) illnesses
Want to know more?
Antiretroviral drugs
HIV is treated with antiretrovirals (ARVs), which work against the HIV infection by slowing down the spread of the virus in the body.
A combination of ARVs is used because HIV can quickly adapt and become resistant to one single ARV.
Patients tend to take three or more types of ARV medication. This is known as combination therapy or highly active antiretroviral therapy (HAART).
Some antiretroviral drugs have been combined into one pill, known as a "fixed dose combination". This means that the most common treatments for people just diagnosed with HIV involve taking just one or two pills a day.
Different combinations of ARVs work for different people so the medicine you take will be individual to you.
Once HIV treatment is started, you will probably need to take the medication for the rest of your life. For the treatment to be effective, it will need to be taken on time, every time.
Many of the medicines used to treat HIV can react in unpredictable ways if you take them with other types of medicines.
These include herbal remedies such as St John's Wort, recreational drugs such as cocaine, and some over-the-counter medicines. Always check with clinic staff or your GP before taking any other medicines.
Want to know more?
- nam: Anti-HIV drugs (PDF, 1.37Mb)
- Terrence Higgins Trust: Treatment for HIV
- HIV i-Base: Introduction to combination therapy
Pregnancy
ARV treatment is available to prevent a pregnant woman from passing HIV to her child.
Without treatment, there is a one in four chance that your baby will develop HIV. With treatment, the risk is less than one in a hundred.
Advances in treatment mean there is no increased risk of passing the virus to your baby with a normal delivery. However, for some women, a caesarean section may still be recommended.
If you have HIV, do not breastfeed your baby because the virus can be transmitted through breast milk.
If you or your partner has HIV, fertility treatments, such as sperm washing, may be available that will allow you to conceive a child without putting either of you at risk of infection.
Missing a dose
HIV treatment only works if you take your pills on time, every time. Missing even a few doses will increase the risk of your treatment not working.
You will need to develop a daily routine to fit your treatment plan around your lifestyle.
Want to know more?
Side effects
HIV treatment can have unpleasant side effects. If you get serious side effects (which is uncommon) you may need to try a different combination of ARVs.
Common side effects include:
- nausea
- tiredness
- diarrhoea
- skin rashes
- mood changes
- gaining fat on one part of your body while losing it on another
Want to know more?
People with HIV can get treated by their own doctor or by a specialist at an HIV clinic or a GUM clinic.
Services, including support organisations, may work together to provide specialist care and emotional support.
Find out more about living with HIV.
Patients with HIV have an increased risk of developing Reactive arthritis as well.A large number of cases during World Wars I and II focused attention on the triad of arthritis, urethritis, and conjunctivitis (often with additional mucocutaneous lesions) which at that time was also referred to as "Fiessenger-Leroy-Reiter syndrome". These eponyms are now of historic interest only.[8]
Signs and symptomsEdit
Because common systems involved include the eye, the urinary system, and the hands and feet, one clinical mnemonic for Reiter's syndrome is "Can't see, can't pee, can't climb a tree."Symptoms generally appear within 1–3 weeks but can range from 4 to 35 days from the onset of the inciting episode of the disease.The classical presentation of the syndrome starts with urinary symptoms such as burning pain on urination (dysuria) or an increased frequency of urination. Other urogenital problems may arise such as prostatitis in men and cervicitis, salpingitis and/or vulvovaginitis in women.The arthritis that follows usually affects the large joints such as the knees causing pain andswelling with relative sparing of small joints such as the wrist and hand.Eye involvement occurs in about 50% of men with urogenital reactive arthritis syndrome and about 75% of men with enteric reactive arthritis syndrome. Conjunctivitis and uveitis can include redness of the eyes, eye pain and irritation, or blurred vision. Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may come and go.Keratoderma blennorrhagicum due to Reactive arthritisRoughly 20 to 40 percent of the men with the disease develop penile lesions called balanitis circinata (circinate balanitis). A small percentage of men and women develop small hard nodulescalled keratoderma blennorrhagicum on the soles of the feet and, less commonly, on the palms of the hands or elsewhere. In addition, some individuals with reactive arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed. Some patients suffer serious gastrointestinal problems similar to those of the Crohn's disease.About 10 percent of the people with reactive arthritis, especially those with a prolonged course of the disease, will develop cardiac manifestations, including aortic regurgitation and pericarditis. Reiter's Syndrome has been described as a pre-cursor for other joint conditions, includingankylosing spondylitis.In the oral cavity, the patients may suffer from recurrent aphthous stomatitis, geographic tongueand migratory stomatitis in higher prevalence than the general population.[9]
CausesEdit
See also: List of human leukocyte antigen alleles associated with cutaneous conditionsReactive arthritis is associated with the HLA-B27 gene on chromosome 6 and by the presence ofenthesitis as the basic pathologic lesion[10] and is triggered by a preceding infection. The most common triggering infection in the US is a genital infection with Chlamydia trachomatis ad other bacteria known to cause reactive arthritis which are more common worldwide are Ureaplasma urealyticum, Salmonella spp., Shigella spp., Yersinia spp., and Campylobacter spp.[11] A bout offood poisoning or a gastrointestinal infection may also precede the disease (those last fourgenera of bacteria mentioned are enteric bacteria). There is some circumstantial evidence for other organisms causing the disease, but the details are unclear.[12] Reactive arthritis usually manifests about 1–3 weeks after a known infection. The mechanism of interaction between the infecting organism and the host is unknown. Synovial fluid cultures are negative, suggesting that reactive arthritis is caused either by an over-stimulated autoimmune response or by bacterial antigens which have somehow become deposited in the joints.
DiagnosisEdit
There are few clinical symptoms, but the clinical picture is dominated by arthritis in one or more joints, resulting in pain, swelling, redness, and heat sensation in the affected areas.The urethra, cervix and the throat may be swabbed in an attempt to culture the causative organisms. Cultures may also be carried out on urine and stool samples or on fluid attained byarthrocentesis.Tests for C-reactive protein and erythrocyte sedimentation rate are non-specific tests that can be done to corroborate the diagnosis of the syndrome. Also, a blood test for the genetic markerHLA-B27 may be performed. About 75 percent of all the patients with Reiter's arthritis display this gene.
Diagnostic Criteria
Although there are no definitive criteria to diagnose the existence of reactive arthritis, theAmerican College of Rheumatology has published sensitivity and specificity guidelines.[13]Percent Sensitivity and Specificity of Various Criteria for Typical Reiter's SyndromeMethod of diagnosisSensitivitySpecificity1. Episode of arthritis of more than 1 month with urethritis and/or cervicitis84.3%98.2%2. Episode of arthritis of more than 1 month and either urethritis or cervicitis, or bilateral conjunctivitis85.5%96.4%3. Episode of arthritis, conjunctivitis, and urethritis50.6%98.8%4. Episode of arthritis of more than 1 month, conjunctivitis, and urethritis48.2%98.8%
TreatmentEdit
The main goal of treatment is to identify and eradicate the underlying infectious source with the appropriate antibiotics if still present. Otherwise, treatment is symptomatic for each problem.Analgesics particularly NSAIDs, sulfasalazine, steroids and immunosuppressants may be needed for patients with severe reactive symptoms that do not respond to any other treatment.
PrognosisEdit
Reactive arthritis may be self-limiting, frequently recurring, chronic or progressive. Most patients have severe symptoms lasting a few weeks to six months. 15 to 50 percent of cases have recurrent bouts of arthritis. Chronic arthritis or sacroiliitis occurs in 15-30 percent of cases. Repeated attacks over many years are common, and patients sometimes end up with chronic and disabling arthritis, heart disease, amyloid deposits, ankylosing spondylitis, immunoglobulin A nephropathy, cardiac conduction abnormalities, or aortitis with aortic regurgitation.[14]However, most people with reactive arthritis can expect to live normal life spans and maintain a near-normal lifestyle with modest adaptations to protect the involved organs.
Epidemiology
History and EponymEdit
When reactive arthritis appears in a triad that also includes ophthalmic and urogenital manifestations, the eponym "Reiter's syndrome" is often applied; German physician Hans Conrad Julius Reiter described the condition in a soldier he treated during World War I.A number of physicians have suggested that the eponym is undeserved. Dr. Reiter's Nazi Partyaffiliation, and in particular his involvement in forced human experimentation in the Buchenwald concentration camp (which, after his capture at the end of World War II, resulted in hisprosecution in Nuremberg as a war criminal), have come to overshadow his medical accomplishments. Furthermore, he was not the first physician to make associations between the arthritis and other symptoms -- the names arthritis urethritica, venereal arthritis and polyarteritis enterica had previously been applied -- and the full triad was described by another physician in the 19th century.[17]
Notable casesEdit
It has been postulated that Italian-born explorer Christopher Columbus suffered from Reiter's arthritis, dying from a heart attack caused by the condition.[18]Scottish football player Ian Murray has suffered from Reiter's arthritis.[19]Australian singer, and frontman of the band silverchair, Daniel Johns was diagnosed with Reactive Arthritis in early 2002 which prevented the band from touring their album Diorama.Former KISS guitarist Mark St. John suffered with reactive arthritis, which prevented him from playing live shows and limited his tenure in the band.South African record-holding sprinter Paul Nash suffered a complete breakdown of his health and ability to train and compete upon developing reactive arthritis in 1968 at the age of 21
Based on Columbus' lifestyle and the described symptoms, modern doctors suspect that he suffered from Reiter's Syndrome, rather than gout.[83][84] Reiter's Syndrome is a common presentation of reactive arthritis, a joint inflammation caused by intestinal bacterial infections or after acquiring certain sexually transmitted diseases (primarily chlamydia or gonorrhea). “It seems likely that [Columbus] acquired reactive arthritis from food poisoning on one of his ocean voyages because of poor sanitation and improper food preparation,” writes Dr. Frank C. Arnett, arheumatologist and professor of internal medicine, pathology and laboratory medicine the University of Texas Medical School at Houston.[83]
Patients with HIV have an increased risk of developing Reactive arthritis as well.A large number of cases during World Wars I and II focused attention on the triad of arthritis, urethritis, and conjunctivitis (often with additional mucocutaneous lesions) which at that time was also referred to as "Fiessenger-Leroy-Reiter syndrome". These eponyms are now of historic interest only.[8]
Signs and symptomsEdit
Because common systems involved include the eye, the urinary system, and the hands and feet, one clinical mnemonic for Reiter's syndrome is "Can't see, can't pee, can't climb a tree."Symptoms generally appear within 1–3 weeks but can range from 4 to 35 days from the onset of the inciting episode of the disease.The classical presentation of the syndrome starts with urinary symptoms such as burning pain on urination (dysuria) or an increased frequency of urination. Other urogenital problems may arise such as prostatitis in men and cervicitis, salpingitis and/or vulvovaginitis in women.The arthritis that follows usually affects the large joints such as the knees causing pain andswelling with relative sparing of small joints such as the wrist and hand.Eye involvement occurs in about 50% of men with urogenital reactive arthritis syndrome and about 75% of men with enteric reactive arthritis syndrome. Conjunctivitis and uveitis can include redness of the eyes, eye pain and irritation, or blurred vision. Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may come and go.Keratoderma blennorrhagicum due to Reactive arthritisRoughly 20 to 40 percent of the men with the disease develop penile lesions called balanitis circinata (circinate balanitis). A small percentage of men and women develop small hard nodulescalled keratoderma blennorrhagicum on the soles of the feet and, less commonly, on the palms of the hands or elsewhere. In addition, some individuals with reactive arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed. Some patients suffer serious gastrointestinal problems similar to those of the Crohn's disease.About 10 percent of the people with reactive arthritis, especially those with a prolonged course of the disease, will develop cardiac manifestations, including aortic regurgitation and pericarditis. Reiter's Syndrome has been described as a pre-cursor for other joint conditions, includingankylosing spondylitis.In the oral cavity, the patients may suffer from recurrent aphthous stomatitis, geographic tongueand migratory stomatitis in higher prevalence than the general population.[9]
CausesEdit
See also: List of human leukocyte antigen alleles associated with cutaneous conditionsReactive arthritis is associated with the HLA-B27 gene on chromosome 6 and by the presence ofenthesitis as the basic pathologic lesion[10] and is triggered by a preceding infection. The most common triggering infection in the US is a genital infection with Chlamydia trachomatis ad other bacteria known to cause reactive arthritis which are more common worldwide are Ureaplasma urealyticum, Salmonella spp., Shigella spp., Yersinia spp., and Campylobacter spp.[11] A bout offood poisoning or a gastrointestinal infection may also precede the disease (those last fourgenera of bacteria mentioned are enteric bacteria). There is some circumstantial evidence for other organisms causing the disease, but the details are unclear.[12] Reactive arthritis usually manifests about 1–3 weeks after a known infection. The mechanism of interaction between the infecting organism and the host is unknown. Synovial fluid cultures are negative, suggesting that reactive arthritis is caused either by an over-stimulated autoimmune response or by bacterial antigens which have somehow become deposited in the joints.
DiagnosisEdit
There are few clinical symptoms, but the clinical picture is dominated by arthritis in one or more joints, resulting in pain, swelling, redness, and heat sensation in the affected areas.The urethra, cervix and the throat may be swabbed in an attempt to culture the causative organisms. Cultures may also be carried out on urine and stool samples or on fluid attained byarthrocentesis.Tests for C-reactive protein and erythrocyte sedimentation rate are non-specific tests that can be done to corroborate the diagnosis of the syndrome. Also, a blood test for the genetic markerHLA-B27 may be performed. About 75 percent of all the patients with Reiter's arthritis display this gene.
Diagnostic Criteria
Although there are no definitive criteria to diagnose the existence of reactive arthritis, theAmerican College of Rheumatology has published sensitivity and specificity guidelines.[13]Percent Sensitivity and Specificity of Various Criteria for Typical Reiter's SyndromeMethod of diagnosisSensitivitySpecificity1. Episode of arthritis of more than 1 month with urethritis and/or cervicitis84.3%98.2%2. Episode of arthritis of more than 1 month and either urethritis or cervicitis, or bilateral conjunctivitis85.5%96.4%3. Episode of arthritis, conjunctivitis, and urethritis50.6%98.8%4. Episode of arthritis of more than 1 month, conjunctivitis, and urethritis48.2%98.8%
TreatmentEdit
The main goal of treatment is to identify and eradicate the underlying infectious source with the appropriate antibiotics if still present. Otherwise, treatment is symptomatic for each problem.Analgesics particularly NSAIDs, sulfasalazine, steroids and immunosuppressants may be needed for patients with severe reactive symptoms that do not respond to any other treatment.
PrognosisEdit
Reactive arthritis may be self-limiting, frequently recurring, chronic or progressive. Most patients have severe symptoms lasting a few weeks to six months. 15 to 50 percent of cases have recurrent bouts of arthritis. Chronic arthritis or sacroiliitis occurs in 15-30 percent of cases. Repeated attacks over many years are common, and patients sometimes end up with chronic and disabling arthritis, heart disease, amyloid deposits, ankylosing spondylitis, immunoglobulin A nephropathy, cardiac conduction abnormalities, or aortitis with aortic regurgitation.[14]However, most people with reactive arthritis can expect to live normal life spans and maintain a near-normal lifestyle with modest adaptations to protect the involved organs.
Epidemiology
History and EponymEdit
When reactive arthritis appears in a triad that also includes ophthalmic and urogenital manifestations, the eponym "Reiter's syndrome" is often applied; German physician Hans Conrad Julius Reiter described the condition in a soldier he treated during World War I.A number of physicians have suggested that the eponym is undeserved. Dr. Reiter's Nazi Partyaffiliation, and in particular his involvement in forced human experimentation in the Buchenwald concentration camp (which, after his capture at the end of World War II, resulted in hisprosecution in Nuremberg as a war criminal), have come to overshadow his medical accomplishments. Furthermore, he was not the first physician to make associations between the arthritis and other symptoms -- the names arthritis urethritica, venereal arthritis and polyarteritis enterica had previously been applied -- and the full triad was described by another physician in the 19th century.[17]
Notable casesEdit
It has been postulated that Italian-born explorer Christopher Columbus suffered from Reiter's arthritis, dying from a heart attack caused by the condition.[18]Scottish football player Ian Murray has suffered from Reiter's arthritis.[19]Australian singer, and frontman of the band silverchair, Daniel Johns was diagnosed with Reactive Arthritis in early 2002 which prevented the band from touring their album Diorama.Former KISS guitarist Mark St. John suffered with reactive arthritis, which prevented him from playing live shows and limited his tenure in the band.South African record-holding sprinter Paul Nash suffered a complete breakdown of his health and ability to train and compete upon developing reactive arthritis in 1968 at the age of 21
Based on Columbus' lifestyle and the described symptoms, modern doctors suspect that he suffered from Reiter's Syndrome, rather than gout.[83][84] Reiter's Syndrome is a common presentation of reactive arthritis, a joint inflammation caused by intestinal bacterial infections or after acquiring certain sexually transmitted diseases (primarily chlamydia or gonorrhea). “It seems likely that [Columbus] acquired reactive arthritis from food poisoning on one of his ocean voyages because of poor sanitation and improper food preparation,” writes Dr. Frank C. Arnett, arheumatologist and professor of internal medicine, pathology and laboratory medicine the University of Texas Medical School at Houston.[83]
