Untreated HIV eventually leads to AIDS. The first cluster of AIDS cases were reported in New York and San Francisco in 1981. Doctors noticed that gay men were becoming ill with a rare form of pneumonia (PCP) and a cancer called Kaposi's sarcoma. Researchers worked out that these men had an underlying infection, and that it was likely to be sexually transmitted and blood-borne. Further cases of AIDS were soon reported in gay men in other countries, including the UK. But it quickly became apparent that AIDS was affecting other groups as well.

In 1985, the virus that is now known as HIV was identified. Even before HIV was discovered, safer sex and safer drug use had become established ways of reducing the risk of the illness.
As the virus spread around the world and deaths mounted, research went into finding a cure or vaccine. The first drug found to have an effect against HIV was AZT. Other drugs were developed as it became clear that treatment with one drug alone did not work well in the long term. Treatment with two anti-HIV drugs was shown to have more benefit, but the real breakthrough came with development of new anti-HIV drugs that worked against the virus in a number of different ways.

In 1996, triple-drug HIV treatment was introduced. This treatment was able to reduce the amount of virus in the blood and allow the immune system to strengthen. Thanks to this treatment, the number of AIDS deaths fell dramatically in countries where treatment was widely available. However, HIV was spreading rapidly in some of the world's poorest countries, especially in southern Africa, and wider access to HIV treatment in these countries is only now starting to become a reality. The early HIV treatment combinations were difficult to take and many caused unpleasant and long-term side-effects. More powerful, easier-to-take and safer drugs gradually became available. Thanks to these, and other improvements in HIV care, doctors have become increasingly hopeful that many people with HIV will be able to live a near-normal lifespan.
Nevertheless, HIV continues to spread. The infection is spreading rapidly in Eastern Europe, China, India and south-east Asia.
HIV is now firmly established as one of the leading health concerns of the 21st century, and one of the most significant causes of illness and death in human history.

Tuberculosis and hepatitis are two conditions that are very common in people who also have HIV. These are diseases that can have an effect on HIV and can also be affected by HIV. They are sometimes referred to as co-infections. Hepatitis B and C are transmitted in similar ways to HIV: by contact with infected body fluids like blood, semen and vaginal fluid, and from a mother to her baby during pregnancy or delivery. Both these types of hepatitis can cause serious liver damage, and liver disease is a major cause of serious illness and death in co-infected patients.
There is a vaccine against hepatitis B. It works well in people with HIV, and everyone who is HIV-positive should receive it. There is no vaccine against hepatitis C. Hepatitis C can be cured with treatment which needs to be taken for up to a year. The best results are seen if treatment is provided soon after a person is infected with the virus. Tuberculosis, or TB, is one of the most common AIDS-defining illnesses. In many cases, HIV was only diagnosed because people became ill with TB. Worldwide, TB is the leading cause of illness and death in people with HIV.
TB is passed on through infected saliva from the coughs or sneezes of an infected person. Once infected, you may not have any symptoms of illness for a very long time. TB causes fever, cough, chest pain and weight loss. It mostly affects the lungs but can affect other parts of the body. Abdominal TB is not uncommon and one can suffer from fever, diarrhea and weight loss.
TB is treated with a combination of anti-TB drugs, which is normally taken for six months. In some cases, it may be necessary for treatment to last longer.

• Rub or tap the area where the needle will go.
• Establish a slow and steady breathing pattern, and then quietly blow out as you feel the needle being placed.
• Close your eyes and visualise a colour or scene.
• If you are likely to feel woozy or faint, tell the nurse in advance. The blood can be taken while you are lying down, which will help avoid fainting and injury.

• Use of CD4 Count for Initial Assessment. The CD4 count is one of the most important factors in the decision to initiate antiretroviral therapy and/or prophylaxis for opportunistic infections. All patients should have a baseline CD4 count at entry into care.
• Use of CD4 Count for Monitoring Therapeutic Response. An adequate CD4 response for most patients on therapy is defined as an increase in CD4 count in the range of 50–150 cells/mm3 per year, generally with an accelerated response in the first 3 months. Subsequent increases in patients with good virologic control show an average increase of approximately 50–100 cells/mm3 per year for the subsequent years until a steady state level is reached. Some patients who initiate therapy with a severely depleted CD4 count may have a blunted increase in their count despite virologic suppression.

• At Initiation or Change in Therapy. Plasma viral load should be measured before initiation of therapy and preferably within 2–4 weeks, and not more than 8 weeks, after treatment initiation or after treatment modification. Repeat viral load measurement should be performed at 4–8-week intervals until the level falls below the assay’s limit of detection.
• In Patients Who Have Viral Suppression but Therapy Was Modified Due to Drug Toxicity or Regimen Simplification. Viral load measurement should be performed within 2–8 weeks after changing therapy. The purpose of viral load monitoring at this point is to confirm potency of the new regimen.
• In Patients on a Stable Antiretroviral Regimen. Viral load should be repeated every 3–4 months or as clinically indicated. In adherent patients who
  have suppressed viral loads for more than 2–3 years and who are at stable clinical and immunologic status, some clinicians may extend the interval to every 6 months.

• HLA-B*5701-positive patients should not be prescribed abacavir..
• The positive status should be recorded as an abacavir allergy in the patient’s medical record..
• When HLA-B*5701 screening is not readily available, it remains reasonable to initiate abacavir with appropriate clinical counseling and monitoring for any signs of hypersensitivity reaction..

• Coreceptor tropism assay should be performed whenever the use of a CCR5 inhibitor is being considered.
• Coreceptor tropism testing might also be considered for patients who exhibit virologic failure on a CCR5 inhibitor.

• Asses the efficacy of HAARTT
• know the side effects of HAART.-Following algorithm is followed when HAART is started.

It's up to you whom you decide to tell. You will need to weigh up the pros and cons of telling someone that you have HIV. On the one hand, restricting the number of people who know that you have HIV will keep the information private. Some people fear stigma, rejection, or even violence because they have HIV. But by not telling anyone, it can also mean that you're unable to access valuable sources of love, help and support. Many people find that they are loved by their partners and families, supported by their friends, and embraced by their community. Telling current, previous or new sexual partners can be a difficult decision. You could talk this over with someone at your clinic. In some countries, there are laws setting out when you do or don't need to tell certain people about your HIV status. And many countries in the world have some sort of legislation in place to protect people living with HIV against discrimination if they do tell people about their HIV.

The importance of regular check-ups, if you have HIV.
If you have HIV, you should see a doctor regularly for a check-up. Most people with HIV attend ART clinics or specialist HIV clinics that have doctors and other health professionals trained in HIV care. Even if you do not want to take HIV treatment at this stage, regular blood tests will tell you about the health of your immune system and if the disease is progressing. Monitoring the safety and effectiveness of HIV treatment. Before you start taking antiretroviral drugs, or before you switch to a new combination, you should have a number of blood tests. Viral load and CD4 tests will tell you how your HIV disease is progressing.

Your doctor may also test to see if your HIV has developed resistance to any of the antiretroviral drugs. Clinics also do a genetic test (called HLA-B*5701) to see if you may be more likely to develop an allergic reaction to the anti-HIV drug abacavir. This test is most accurate in white people; more information is still needed about its accuracy in people of African or Asian origin.

When you start or change a drug combination, a viral load and CD4 count will be done within the first month of treatment. This is to check that the drugs are working. Testing is generally performed every three months, although some doctors may perform tests more often to begin with and less frequently once you are well established on treatment and doing well. Once you are on HIV treatment, you may have tests to measure liver and kidney function and fat and sugar levels in your blood, to assess the effects of the drugs on the normal workings of your body.
Your HIV care will also involve a number of other routine tests. These will be to monitor your general health and to see if your treatment is causing any side-effects.

Preparing to start your HIV treatment

Taking antiretroviral therapy is a long-term commitment. Once you start the drugs, it is recommended that you continue treatment for the foreseeable future. You are more likely to take your HIV treatment correctly if you are involved in the decisions about when to start treatment and about which drugs to start treatment with. Being honest about your lifestyle with yourself and with your doctor can help ensure that you start on a drug combination that is right for you. So it's a good idea not to make unrealistic demands on yourself, and to think about how taking medication will fit in with your eating and sleeping patterns, and with your work, family and social life. The chances are that there will be a combination of HIV treatment available that will mean you don't have to change your lifestyle at all, or make only modest alterations to your routine.

Taking your HIV treatment
It is very important not to miss doses of your anti-HIV drugs and to take them exactly as prescribed. If you miss doses, or you do not take the drugs as you are supposed to, the HIV in your body is more likely to develop resistance to them. This will reduce their long-term effectiveness. To help make sure that you take the right combination of anti-HIV drugs, you should have a test to see if you already have any drug resistance before you start treatment (it is possible to be infected with a strain of HIV that has built-in resistance to some drugs). If you need to change HIV treatment because your viral load becomes detectable again (see the aim of treatment ), then your choice of new drugs should be guided by having another resistance test at this stage. Even if you have resistance to several drugs, it's good to know that important new anti-HIV drugs have become available in the past few years. An undetectable viral load is a realistic objective for nearly all patients, including those who have taken a lot of different treatments in the past and have drug-resistant virus. If you are having difficulty sticking to your drug routine, discuss alternative combinations that may be easier to take with your doctor. There are many tips and aids which may improve your ability to take your drugs as required.

Side-effects
Quite often, people experience side-effects when taking antiretroviral drugs, especially during the first few weeks of treatment. Your doctor can prescribe a number of drugs to help you cope with this initial period. Side-effects most commonly reported include headache, nausea, diarrhoea, and tiredness. You don't have to 'grin and bear' side-effects - report them, especially rash and fever, to your doctor promptly.

Drug interactions
Taking two or more different drugs together may result in an alteration in the effectiveness (or side-effects) of one or more of the drugs being taken. Some prescription drugs and some drugs you can buy over the counter at a chemist should not be taken in combination with certain antiretrovirals. It's therefore important that your doctor and pharmacist know about all other medicines and drugs that you are taking - this includes those prescribed by another doctor, over-the-counter remedies, herbal and alternative treatments, and recreational drugs. Some antiretroviral drugs lower or increase levels of other antiretroviral drugs. Some interact with other medicines commonly used in the treatment of HIV. Some drug combinations are contraindicated - which means you definitely should not take them together. Reasons for this include serious side-effects or interactions which make one or both drugs ineffective. Other interactions are less dangerous, but still need to be taken seriously. Levels of one or both drugs in your blood may be affected and dosing adjustments may be required. Some drug interactions may mean that you have a greater chance of developing certain side-effects. Your HIV doctor and pharmacist will check for possible interactions before you start treatment with a new drug. If any other healthcare professional prescribes you medicine, it's important that they know about the drugs you are taking for your HIV. For example, it's known that treatments for erectile dysfunction such as Viagra can interact with protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTIs). These interactions can increase blood levels of Viagra and similar drugs, increasing the risk of side-effects. Some anti-HIV drugs can interact with antihistamines, treatments for indigestion, and statins - drugs that are used to control cholesterol (lipid levels). These treatments can either be prescribed or bought over the counter at chemists. If you are using these drugs, you should tell your HIV doctor or pharmacist so they can check for possible interactions and recommend the most suitable. Less is known about interactions with recreational drugs. However, if you use recreational drugs, it is sensible to discuss this with your doctor.

Antiretrovirals can also interact with herbal and alternative treatments. It is known that the herbal antidepressant St John's wort lowers blood levels of NNRTIs and protease inhibitors. Garlic capsules stop the protease inhibitor saquinavir (Invirase) from working properly and it is thought that they could have a similar effect on other protease inhibitors as well. Test-tube studies have indicated that African potato and Sutherlandia interfere with the body's ability to process protease inhibitors and NNRTIs.
Interactions can even happen with medicines that are not taken by mouth. For example, ritonavir can interact with inhalers and nasal sprays containing fluticasone (e.g. Flixotide, Seretide andFlixonase), causing serious side-effects. Make sure you tell your clinic doctor about all the medicines you are taking. This includes prescribed medicines, medicines you buy from a chemist, herbal or traditional medicines, and recreational drugs.

HIV treatment and pregnancy
Antiretroviral drugs are now commonly used during pregnancy as an effective means of preventing the transmission of HIV from a mother to her baby. Although the long-term effects on the child are not yet clear, evidence so far suggests that HIV treatment during pregnancy is safe. Taking HIV treatment during pregnancy greatly reduces the risk of passing on HIV to the baby, so the benefits outweigh any risks. Generally, anti-HIV drugs are not used during the first three months of pregnancy unless the woman is already on treatment. Pregnant women usually begin HIV treatment at the beginning of the 14th week of pregnancy,

As a woman's health improves, her fertility may also increase. It is recommended that women considering pregnancy, or women who may conceive, discuss their treatment options with their doctor before conceiving. One reason for this is that some anti-HIV drugs (e.g. efavirenz, also in the combination pill tofoday, viraday, duovir-E, Atripla) are not usually recommended for women who are planning a pregnancy. You should tell your HIV doctor or another member of your healthcare team immediately if you become pregnant. Hormonal contraception is less effective in women on many of the anti-HIV drugs due to drug interactions. Other forms of contraception are unaffected by HIV treatment. There is no evidence that a father's treatment increases the risk of birth defects.