Care and treatment

Everyone living in Sweden is entitled to free treatment.

Free treatment

You have the right to free treatment. Doctor's visits, tests and medicines related to your HIV infection are free of charge. This applies to everyone living in Sweden, even if you are an asylum seeker or undocumented migrant. For other medical visits and dental care, you have to pay as usual.

Participation

You have the right to be involved in all decisions about your treatment, in consultation with your doctor and healthcare professionals. This means that you have the right to change treatment if you feel uncomfortable with it, and also the right to remain on a treatment that you are satisfied with. Your wishes and needs should be at the heart of the matter. You have the right to change your doctor. If you feel that you are being mistreated, you have the right to file a complaint against the healthcare system.

Rules of conduct

Your doctor will give you a code of conduct that you must follow. You have the right to discuss these rules and the right to an individual assessment. You can appeal against your doctor's decision to the infectious disease doctor in your region.

Mental and sexual health

You have the right to psychosocial support and the right to choose who you want to talk to. You also have the right to support in regards to sexuality and sexual matters. Not all clinics have a counselor, but you still have the right to see a counselor if you want to. Talk to your doctor.

Confidentiality & record keeping

Healthcare professionals and interpreters are bound by professional secrecy and confidentiality, which means that no one can talk about your status living with HIV or what is said during your visits. Comprehensive record keeping means that all healthcare providers you visit can see what care you have received. The aim is to facilitate treatment and provide better care; for example, it may be important to know how different medicines work together. If you do not want this, you have the right to block this information. Since your records cannot be read by different healthcare providers, you have a duty to inform them if there is a risk of hiv transmission. It may be a good idea to tell your HIV doctor if you are receiving other care. You also have the right to read your own medical records.

Equal treatment

You must not be denied the care you need because you are living with HIV. This also applies to private healthcare providers who are reimbursed by the Swedish Social Insurance Agency.

Combination treatment

There are currently around 20 HIV medicines in five groups on the Swedish market. By combining different drugs, you get combinations that are much more effective than individual drugs on their own. The drugs must also be given in combination to prevent HIV from becoming resistant to the drugs.

With proper treatment, the amount of virus drops to levels that are not even measurable. The immune system usually recovers to normal and infectiousness is minimized. The treatment provides 100% protection against sexual transmission. Research has not been able to provide the same clear results for breastfeeding and blood transmission, but the risk of HIV transmission through sex is zero.

Regular monitoring is important to detect treatment failure. In particular, the amount of virus is measured, but other tests are also needed to detect possible side effects.

Which combination is best?

Often, the doctor and the patient have to work together to find a combination that gives the best possible effect and as few side effects as possible.

A common 'first' combination is two NRTIs plus one NNRTI. Another common starting combination is two NRTIs together with a protease inhibitor.

In patients who have developed resistance to HIV medicines, efforts are made to find a combination of newer medicines to which the patient's virus has not developed resistance. In some cases, however, five or six drugs may be needed to keep the viral load down.

HIV medicines, group by group

  • Nucleoside analogues (NRTIs) are almost always part of a combination treatment for HIV. Nucleoside analogs work inside HIV-infected cells. The name, nucleoside analogs, is derived from how they resemble naturally occurring building blocks (nucleosides) in the genome of the virus. By first binding to an enzyme in the virus, the nucleoside analogs are built into its genome as 'fake building blocks'. This stops the formation of new virus particles.

  • Non-nucleoside RT inhibitors (NNRTIs) also act inside the HIV-infected cells. NNRTIs affect the same phase of the virus life cycle as the nucleoside analogs, but in a slightly different way. Virus replication is stopped by blocking an enzyme in HIV.

  • Protease inhibitors are a group of HIV medicines that have been available in Sweden since 1996. These medicines block the protease enzyme in HIV. This enzyme is needed to split large proteins into smaller ones in the formation of new virus particles. Blocking the splitting process prevents the virus from multiplying.

  • Integrase inhibitors work by preventing HIV from integrating into the DNA of the target cell that the virus is about to infect.

  • Entry inhibitors prevent the virus from entering the body's cells. These medicines therefore act earlier in the life cycle of the virus than other medicines. The first drug in the group is a so-called fusion inhibitor, which must be taken in the form of self-injections. Fusion inhibitors prevent the virus from infecting cells by blocking a protein that HIV releases to enter a host cell. The fusion between the virus and the host cell is prevented. So far, fusion inhibitors are used when other combinations of HIV drugs have been tried, for example when resistance and side effects occur. There are also other entry inhibitors that inhibit other receptors that viruses use to infect other cells.