AIDS (HIV): Therapy

General measures

  • Partner management in the case of a fresh HIV infection, i.e., infected partners, if any, must be located and treated (contacts from the last three months or from the time until the last negative test must be informed).
  • No unprotected intercourse! – unprotected anal intercourse/anal sex is the highest-risk practice for both individuals (receptive 0.82%, insertive 0.07%); unprotected vaginal intercourse is considered the second highest-risk route of infection
  • No needle sharing – sharing needles and other injection equipment among drug abusers.
  • Watch for possible blood contact and avoid sharing nail scissors, razors, and toothbrushes with noninfected persons.
  • Observance of general hygiene measures!
  • In the occurrence of fever:
    • Bed rest and physical rest (even with only a slight fever).
  • Nicotine restriction (refrain from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Limited caffeine consumption (max 240 mg of caffeine per day; equivalent to 2 to 3 cups of coffee or 4 to 6 cups of green/black tea).
  • Strive to maintain a normal weight! Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis.
    • Falling below the BMI lower limit (from the age of 19: 19; from the age of 25: 20; from the age of 35: 21; from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for underweight people.
  • Education about activity restriction and occupational ban: infection with the HIV pathogen is not included in § 42 of the Infection Protection Act (IfSG) among the pathogens that lead to activity restriction for people who are professionally involved with food. An activity restriction may be necessary for physicians performing surgery due to the risk of exposure to others. Activities with an increased risk of transmission of blood-borne infectious diseases should be excluded. See “Prevention of nosocomial transmission of human immunodeficiency virus (HIV) by HIV-positive healthcare workers.
  • Travel recommendations
    • Attention to entry restrictions for HIV-infected persons in some countries.
    • Consideration of higher risk of travel-associated infections.
    • Observe behavioral measures for infection prophylaxis (repellents for malaria protection; vaccination check).

Conventional non-surgical therapy methods

  • Stem cell transplantation (more precisely, hematopoietic stem cell transplantation; HSCT)-an HIV patient has been in remission for months without antiretroviral therapy after a stem cell transplant; he received a transplant of allogeneic hematopoietic stem cells (HSC) on which both alleles had a gene depletion for the CCR5 receptor (CCR5Δ32/Δ32) (“London patient”: Second case of this kind)The “London Patient”, the second case after the “Berlin Patient”, is virus-free even after 30 months without HIV therapy. Note: There is a critical window of opportunity for HIV reinfection of donor cells in individuals with HIV-1.

Vaccinations

In HIV-positive individuals, the following vaccinations should be given against:

  • Influenza vaccination
  • Hepatitis A, B
  • Herpes zoster due topersons ≥ 50 years with increased health risk as a result of an underlying disease (here: HIV).
  • PneumococcalNote: In patients with immunosuppression, the STIKO advises sequential vaccination, first with PCV13 (conjugate vaccine) and 6-12 months later with PSV23 (23-valent polysaccharide vaccine). This strategy has significantly higher protective efficacy than when vaccinated with PSV23 alone.

Nutritional Medicine

  • Nutritional counseling based on nutritional analysis
  • Observance of the following specific dietary recommendations during the disease:
    • Sufficient fluid intake! Since during the course of a febrile illness there is a strong loss of fluids, fluid intake in adults with kidney and heart health should be according to the following rule of thumb: for each degree of body temperature above 37 °C, an additional 0.5-1 liters per °C. Teas are best suited.
    • In case of vomiting: as long as vomiting continues, the consumption of any food should be avoided. However, it is essential to compensate for the loss of fluids. For this purpose, it is advisable to add liquids such as herbal teas (fennel, ginger, chamomile, peppermint and caraway tea) or water initially in smaller quantities, possibly by the spoonful. When vomiting has stopped, carbohydrate foods such as rusks, toast, and pretzel sticks are well tolerated at first. Meals should be small and eaten throughout the day. Stimulants should be avoided during vomiting and for a week afterwards.
    • For diarrhea: In the context of diarrhea, a “tea rusk diet” (duration: three days, longer if necessary; as long as no other diseases speak against it) has proven itself.
    • After the acute gastrointestinal disease, a light full diet is recommended. Within the framework of this diet, the following foods and preparation methods should be avoided, as experience has shown that they often cause discomfort:
      • Voluminous and fatty meals
      • Legumes and vegetables such as white cabbage, kale, peppers, sauerkraut, leeks, onions, savoy cabbage, mushrooms.
      • Raw stone and pome fruit
      • Fresh bread, wholemeal bread
      • Hard boiled eggs
      • Carbonated drinks
      • Fried, breaded, smoked, very spicy or very sweet foods.
      • Too cold or too hot food
    • Diet rich in:
      • Vitamins (vitamin A, B1, B2, B3, B5, B6, B12, C, E) – Due to the fever may be deficient in vitamin C. In addition, vitamin C is important for the immune system. Foods rich in vitamin C are vegetables such as spinach and fruits (oranges, strawberries, kiwis, currants), which are also well tolerated during an infection.
      • Trace elements (selenium, zinc)
      • Omega-3 fatty acids (marine fish)
      • Secondary plant substances
      • Other micronutrients (L-carnitine; probiotic cultures).
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine