HIV treatment
There is effective medication for HIV, and it maintains the health of a person living with HIV. The life expectancy of people living with HIV is the same as for HIV-negative people, and effective HIV medication prevents the transmission of HIV.
In Finland, HIV is treated in specialised healthcare in the infectious diseases outpatient clinics of central hospitals or university hospitals, depending on where the person lives. When HIV is diagnosed and a confirmatory test has given a positive result, the person will be referred to specialised healthcare.
After HIV infection is diagnosed, various blood tests are taken at the so-called initial visit to the infectious diseases outpatient clinic (HIV viral load, CD4 cell count and possible HIV drug resistance in addition to other basic blood tests). Blood tests are used to determine a person’s HIV infection status and general health. At the first visit, the doctor will also confirm that the patient is motivated and committed to treatment.
The aim is to find the best possible treatment for each person, which is why the doctor will ask questions about the patient’s lifestyle, such as their daily rhythm. When choosing HIV medication for women, any plans to become pregnant are also taken into account, so that a medication that is also safe for the foetus can be chosen.
HIV treatment includes follow-up visits to the doctor’s office, usually twice a year
Follow-up visits include a check on the effectiveness of the medication and your general state of health through various laboratory tests and possible imaging tests. Blood samples can be used to examine the condition and function of internal organs, among other things. Early detection of abnormalities helps to improve quality of life and, in the best case, prolong life, as early detection of diseases makes them easier to treat, helps prevent and cure them and to manage chronic diseases.
HIV testing, treatment and medication are free of charge to the user. Your municipality of residence is responsible for the costs of testing and treatment for HIV infection. The infectious diseases outpatient clinic mainly treats people living with HIV, and in the event of other illnesses, people living with HIV should contact basic healthcare or occupational healthcare.
HIV medication
HIV infection is treated with a combination of medication, usually 2–3 different types of medicine. The combination of medication prevents the virus from replicating and lowers the HIV viral load in the blood to an undetectable level. This means that the virus cannot be measured in the blood at a level above the measurement threshold. The meter used in Finland is very sensitive, with a measurement threshold of 20 copies/ml in viral load. A meter with a measurement threshold of 50 copies/ml in viral load is commonly used worldwide. For HIV transmission studies, the measurement threshold is 200 copies/ml. (U=U)
There are already more than 30 different medicines available to treat HIV, which means that there is a suitable treatment for everyone
The effectiveness of the HIV medication is monitored at the beginning, such as with HIV viral load tests. At the beginning, it is also important to make sure that the medication does not cause any problems and that all internal organs are functioning well during the medication. When the medication is found to be effective and safe and the viral load is undetectable, monitoring can be reduced.
The treating doctor has the expertise and knowledge to prescribe the right medication for each individual’s needs. The choice of medication is influenced by factors such as other medications used by the patient. HIV medicines are well tolerated, and the wide range of medication available means there is a suitable medication for everyone.
Tablets are the most commonly used medication for HIV. In 2021, a longer-acting injectable HIV medication was also introduced. Injectable medication is first started in tablet form to check for possible side effects. If the doctor concludes that the medication is suitable and effective, the medication will then be administered every two months. The injection is taken at a healthcare facility, and it cannot be self-administered, at least for the time being. Read more about the injectable medication below.
The compatibility of medication prescribed for other conditions with HIV medication should always be checked with the treating doctor to avoid possible adverse interactions between medication. However, it is up to each person living with HIV to decide whether to tell others about their HIV infection, such as their occupational health service. However, it is recommended to share the information to ensure the safe use of medication.
An English-language database on the interactions between HIV medication and other medication has been compiled on a website maintained by the University of Liverpool. The database is comprehensive, but not complete. The trade names of medication vary from country to country. The active ingredients in the medicine is another way to look for interaction data. The database can be found here.
How is the medication started?
HIV medication is started as soon as possible after diagnosis, as soon as the patient is ready to commit to daily, lifelong medication. The timing of the start of the medication is decided together with the treating doctor. Patients are usually offered a period to consider their choice before starting medication, as a commitment to taking the medication regularly is essential to avoid the development of drug-resistant strains of HIV. Resistant HIV virus strains can form if medication is taken irregularly.
Medication is discussed and decided together with the treating doctor according to each individual’s circumstances. Medication can be obtained from the hospital pharmacy or from a nurse’s appointment. HIV medication is not available from regular pharmacies. HIV medication is free of charge to the user.
Impact on life
HIV treatment requires taking your medication regularly at about the same time every day. Some HIV medication must be taken with a small amount of food to work, while others need to be taken with a certain amount of calories. The treating doctor will give specific instructions on how to use the medication when it is first started. You can always ask the treating medical professionals about the medication if you have any issues or want to make sure you understand the instructions for taking the medication correctly.
Continuing HIV treatment without interruption is essential.
However, since it is possible that a person may be rendered unconscious for a long period of time, for example as a result of an accident or a medical episode, it would be a good idea to have information about the HIV infection in the database of your wellbeing services county. This ensures that the medication can be continued even in unexpected situations. On Kanta.fi, you can give consent to what information about yourself you give to healthcare professionals.
Healthcare professionals have a duty of confidentiality, and there are very strong penalties for breaching it. Over time, taking medication becomes a routine that is an integral part of life. Taking medication may be the only thing that reminds you of being HIV-positive in your everyday life.
Injectable HIV medicine
Further development of HIV medication is ongoing. More recently, longer-acting and injectable HIV medication has been introduced to the market. Injectable HIV medication is available in Finland. If you are interested in starting injectable medication, it is a good idea to discuss it with your doctor. Injectable PrEP medication is not used in Finland.
How is injectable medical treatment started?
The medication is started with a tablet therapy of the active ingredients of the injectable medication, rilpivirine and cabotegravir. Starting with tablet therapy of the active substances ensures that any problems, such as an allergic reaction, can be addressed quickly by stopping the tablet therapy if necessary.
Treatment with injections can be started after the tolerability of the treatment has first been confirmed with tablet therapy. The user can then receive their first injections. The first and second injections are administered one month apart from each other, after which the interval between injections is changed to two months.
Injectable medication can only be started when the viral load is below the detectable level. This means that if medication is being started for a newly diagnosed person with a measurable viral load, the viruses must be treated with some other combination of three medicines before starting the person on the injectable drug. Only then can the injectable medication be started.
How is the injectable medication administered in practice?
The medicine is injected into the body in two separate injections. One of the medications must be kept cold and cannot be combined. The injection is administered in a buttock, and it can only be administered by a healthcare professional. As such, this type of treatment results in more visits to a nurse.
Each injection must be administered at two-month intervals with a window of +/- 1 week to ensure the medication is effective. The medicine remains in the body long after the last injection, and if the medication is changed to another, it must be done in time to avoid the HI-virus developing resistance while the medicine concentration is too low. The possibility of longer treatment intervals is currently being studied.
What does the current injectable medication contain?
The two active ingredients of the medication are cabotegravir and rilpivirine. Cabotegravir is an integrase inhibitor with a molecular structure close to that of dolutegravir, which was used in previous combination therapies. Rilpivirine is a generally well tolerated reverse-transcriptase inhibitor.
Is the injectable medication effective?
The injectable medication is effective. The use and research of dual-ingredient medication has also advanced significantly for non-injectable medication as well. Reducing the need for medication is beneficial for the patient. Injectable medication is at least known to reduce the strain on internal organs.
Doesn’t a long administration interval affect the medication’s effectiveness?
A long administration interval does not affect the medication’s effectiveness. The longer administration interval was precisely what the medical research sought for, and the research has been properly conducted. Despite the administration intervals, the concentration of the medicine in the body remains sufficiently constant and sufficiently high.
Do the injections cause soreness at the injection site? Is it apparent to other people?
There is often soreness at the injection site for 1–2 days, similar to after vaccinations. In both injections, 3 ml of the medicine is injected into the body. Those who have participated in the medication test groups have found that the soreness decreases as more injections are administered. Some people may get a small bruise at the injection site, but this is no different from a normal injection, such as a vaccination.
What are the benefits of injectable medication?
Not having a daily reminder of HIV infection in the form of a pill or multiple pills has been found to improve people’s quality of life. When the medicine is in your system, you do not have to constantly think about its concentration or worry that someone inappropriate might see the contents of your medicine bottles. Therefore, injectable medication can be a good option for people with HIV who travel a lot, for example.
Many people who have switched to injectable medication feel that HIV has had less of an impact on their life because they no longer have to worry about taking their daily medication. Similarly, for those who have had problems keeping their HIV medication at home, carrying the medicine in their own body has been a relief.
Is the injectable medication better than previous types of medication?
Orally administered medication is still effective. Medication and types of medication are always discussed and agreed with an infectious disease doctor.
What can prevent you from starting the use of injectable medication?
Contraindications to the medication include viruses resistant to any of the active ingredients, hypersensitivity to any of the ingredients in the medication or, in women, pregnancy or intended pregnancy.