Treatment

Combination treatment (braking medication) has been available for people with HIV in Sweden since 1996. Combination therapy involves taking several different medications at the same time. The treatment does not cure the infection but is so effective a person living with HIV can live as long as anyone. The amount of HIV virus in the blood can become so low that it is no longer measurable, but it does not disappear from the body. Treated HIV is not transmitted through sex

There is no conclusion as to what the best combination is. It is the doctors’ task to find the combination that best suits each patient. The antiviral drugs available today are divided into four groups; Nucleoside analog-RT inhibitors (NRTIs), Non-nucleoside analog-RT inhibitors (NNRTIs), Protease inhibitors (PI), and Fusion inhibitors (FI). Which group the drug belongs to depends on where in the virus production the drug does its job. For example, some drugs attack the virus when it tries to enter the cell, some prevent new viruses from maturing, and so on.

Some of the medications used can cause side effects. Some side effects may disappear after a few weeks, while others may last longer. It is important that the patient carefully follows the doctor’s instructions in order for the effect to remain and for the virus not to develop resistance to the drugs. According to Swedish infection prevention legislation, the medications are free of charge for the individual patient.

Preventive treatment (PrEP)

Preventive treatment that can be given before a person is exposed to an infectious agent is called Pre-Exposure Prophylaxis (PrEP). There is also Post-Exposure Prophylaxis (PEP), which is given after exposure, to prevent infection from occurring. These two treatments are prescribed as antivirals, and are often included in the treatment of people with HIV. It also makes it possible to prevent an HIV-negative person from getting HIV. HIV prevention treatment is a good option for people who have sex with multiple partners without a condom and, for a limited time, also for those living with someone who has HIV where treatment has not yet been effective.

Having sex with a person who has treated HIV with a virus load below detectable level means no transmission of HIV. In this case, PrEP is unnecessary. In principle, many different drug combinations can be considered as PrEP, but only the drug Truvada has currently been thoroughly studied for almost 10 years. More information on treatment with PrEP:

• Truvada is used as PrEP in the United States and in several EU countries.
• It is given as one tablet a day for a longer period, or if needed: 2 tablets, 2 to 24 hours before ‘planned’ sex and then 1 tablet daily for two days – if there was only one sexual encounter. Otherwise, Truvada can be continued according to the same principle: 2 tablets before sex as above and one tablet a day for up to two days after the last sexual encounter that involved a risk of HIV transmission.
• Treatment with Truvada can affect bone density in the skeleton; it can also, but more rarely, affect the kidneys. Therefore, patients taking Truvada must be monitored at least once a year.
• Before starting PrEP, a person’s HIV status must be ruled out. The risk of transmitting HIV while taking PrEP is very low if the medicine is taken as prescribed. However, any transmission of HIV must be detected as soon as possible, as Truvada is not enough to treat an HIV infection.
• HIV testing before starting treatment is essential, as is regular testing while taking PrEP, probably every three months.
• Not using condoms puts you at risk of HIV, but also of other sexually transmitted infections. Truvada does not protect against any other diseases than HIV.

If you are thinking of obtaining Truvada on your own, please note that antiviral medication must be taken in an organized manner with regular check-ups.

Read about PrEP (link to Lars Moberg’s text).

Read more about Truvada in Fass.

In Region Stockholm, PrEP is given at the specialist clinic Venhälsan and the Infection clinic in Huddinge, but from September 2024 this will be expanded to five additional clinics: the RFSU clinic for sexual health in Södermalm, the City clinic for sexual health in Östermalm, Stockholm’s clinic for sexual health in Vasastan, Älvsjö Sexual Health and a clinic that will open in the district of Haga in Solna.