Treatment

Although there is no cure for HIV/AIDS, several treatments can be used to prolong the lives of those infected with HIV, reduce the chance of mother-to-child transmission, or prevent HIV infection after exposure to the virus (post-exposure prophylaxis).

Antiretroviral Treatment

Although antiretroviral treatment is not a cure for HIV/AIDS, it can significantly prolong and improve the lives of HIV-infected people.

There is still debate over when to start antiretroviral treatment. Because the ARV treatment has known side effects, including short and long-term toxic effects on the body, medical specialists disagree over when to start the therapy.

In South Africa, treatment is started when the patient's CD4 count is below 200. If a patient has TB and in pregnant women, treatment will be initiated when the CD4 count is anywhere below 350. With multiple or extreme drug resistant TB (M/XDR TB) treatment will be started irrespective of CD4 count. Similarly, treatment is started immediatiately when a patient presents with WHO stage 4 symptoms.

Antiretroviral treatment is usually a combination of drugs. The three main types of drugs available are listed below:

Antiretroviral drug	Action	Generic examples (abbr)
Nucleoside Analogue Reverse Transcriptase Inhibitor (NRTI)	Prevents healthy T-cells from becoming infected with HIV by preventing the conversion of viral RNA into viral DNA.	zidovudine (AZT); lamivudine (3TC); zalcitabine (ddC);
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)	Prevents healthy T-cells from becoming infected with HIV by interfering with the reverse transcriptase enzyme which the HIV uses to convert viral RNA to viral DNA.	nevirapine (NVP, delavirdine (DLV), efavirenza (EFV)
Protease Inhibitor	Prevents infected T-cells from producing new copies of the virus by blocking the protease enzyme which helps produce new copies of the virus.	lopinavir (LPV), ritonavir (RTV), indinavir (IDV)

Although antiretroviral treatment is available around the world, initial rollout of the drugs in the public sector in South Africa has been slow. (Also see: Treatment factsheet)

The Prevention of Mother-to-Child Transmission (PMTCT)

A woman who is HIV-positive can pass on HIV to her baby during pregnancy, during childbirth and during breastfeeding. In the absence of preventative interventions, the probability that an HIV-positive woman's baby will become infected is approximately 25% – 35%, according to Unicef. Two treatment options, ziduvidine (AZT) and nevirapine, are available to reduce the transmission of HIV/AIDS from mother to child.

Post-Exposure Prophylaxis (PEP)

When individuals are potentially exposed to HIV through sexual assault or occupational exposure, a program of several antiviral drugs may be taken to prevent infection. Although PEP is theoretically available at all public sector hospitals and clinics, South Africa has been criticised by Human Rights Office for the slow rollout of the programme. PEP treatment needs to be commenced within 72 hours, although there is evidence to suggest that the sooner the person commences treatment the greater the benefits.