ARV therapy

How does ARV therapy work?

ARV therapy does not cure HIV but it can stop the spread of the infection and keep your health in a good condition. Drugs prevent HIV from replicating in various stages of the HIV life cycle, keeping the viral load at a low level. The ARV drugs will thereby protect your immune system and prevent the transmission of HIV.

The therapy does not destroy genes hidden in chromosomes by HIV. If you stop taking ARV drugs, new virus particles will be produced based on the viral gene information and the amount of the virus will start growing rapidly.

Where to go for ARV therapy?

If you have been diagnosed with HIV, ARV therapy must be started as soon as possible no matter how long ago you were infected. To get started on ARV therapy you first have to see an infectious disease doctor. While getting the treatment you will have to go to an infectious disease doctor regularly for check-ups and analyses.

ARV therapy and drugs are free for Estonian residents regardless of their health insurance status.

How is the effectiveness of treatment determined?

The effectiveness of treatment is assessed based on two analyses for determining:

1. the viral load, or the amount of the virus in blood by HIV RNA PCR (copies per ml);
2. the level of immunity, or the amount of CD4 cells in the blood (cells per mm3).

Viral load

An HIV RNA PCR analysis is used to determine the viral load or in other words the amount of HIV in the blood. The purpose of the anti-HIV treatment is to reduce the amount of the virus in the body to a level as low as possible. An ideal result is deemed to be a value where the amount of the virus is below the detectable level: HIV RNA PCR < 20 copies per ml. This means that you have been taking your medication properly, your treatment has been successful and you are no longer contagious.

Undetectable viral load

The purpose of the treatment is to achieve an undetectable viral load. This means that the virus is in your blood in such small quantities that it doesn’t affect your health and the risk of transmitting HIV is lower. But remember that as soon as you stop taking the medication, your viral load will go up again.

Level of immunity

CD4 cells are important cells of the immune system that fight infections. HIV destroys CD4 cells, thereby weakening the immune system. A weakened immune system cannot provide enough protection for the body against HIV and other diseases. ARV drugs protect CD4 cells. The higher the CD4 count, the better the result and the stronger the immune system.

Directly controlled treatment (DCT)

For making it easier for people who inject fentanyl and/or other opioids to follow their treatment regimen they have the option of getting medication on a daily basis (also called directly controlled treatment). The patient will get their ARV drugs and methadone at the start of every business day. Weekend medications are given on Friday. This option is currently available at West Tallinn Central Hospital.

Stopping treatment

If you don’t take your medication regularly or you don’t take some of your pills or you stop treatment, the replication of the virus will no longer be under control and the viral load will start increasing. Stopping the taking of medication is something that you always have to decide in consultation with your doctor. If you stop ARV therapy the virus will start replicating in your body again, damaging your immune system. A weakened immune system will not protect you from various infections and the risk of getting cancer will rise. Stopping ARV therapy will also increase the risk of drug resistance.