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FINDING ANSWERS AND HELP - EASILY AND INDIVIDUALLYUn

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HIV

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LIVING POSITIVELYFortunately the times are over when the diagnosis „HIV-positive“ was synonymous with a

significantly shortened life expectancy. With continuous treatment the HIV infection is now

classified as a chronic disease. Today most people infected with HIV have a high quality of life

and a good perspective of being largely able to live a normal life.

The diagnosis HIV changes the entire life. Families, partnerships and friendships are often

placed under severe strain, usually based on fears and lack of knowledge. Regular medical

examinations or if necessary also medicines become permanently necessary.

This brochure explains what HIV actually is and what happens to the body when it has become

infected. It is intended to help you to understand the disease better, as this is the basis for a

positive life.

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Understanding HIV:WHAT HAPPENS IN MY BODY WHEN I AM HIV-POSITIVE?

HIV

HI viruses attack the protective shield consisting of defence cells

The immune system becomes weakened

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CD8CD4Bacteria, viruses, funguses, parasites CD4 cells/CD8 cells

Under normal circumstances our immune system (amongst others CD4 or CD8 cells) is able to defend against

pathogenic organisms so that we remain healthy.

If our immune system is weakened through HIV then other pathogenic organisms are able to multiply

without resistance and we become ill.

Important: HIV is not the same as AIDS.HIV-positive = infected with the human immune defi ciency virus, but not yet fallen ill.AIDS = Acquired Immune Defi ciency Syndrome: Immune defence is severely weakened – the body is no longer able to defend itself against life-threatening diseases (e.g. pneumonia).

The immune system becomes weakened

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Understanding HIV:HOW IS HIV TRANSMITTED?

Important: HIV can only be transmitted from one person to another through the following body fluids: Blood, sperm, vaginal secretion, secretion in the rectum, breast milk.

High transmission risk

Unprotected vaginal sexual intercourse:A condom provides additional protection during sex

Unprotected oral intercourse: Only with condom/no sperm or menstrual blood in the mouth

Drugs: No mutual use of syringes

Pregnancy:Strict medical control/no forgetting of the tablet intake

Unprotected anal sexual intercourse: Penetration only with condom

Breastfeeding period:No breastfeeding

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No transmission risk

Kissing Via breathable air or droplets/with coughing or sneezing

Shaking hands Mutual use of tableware and cutlery

Sauna/swimming pool Via insect stingsThrough medical measures at visit doctor/dentist/in hospital, if usual hygiene regulations are observed.

Use of common/public toilets

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Infection HIV-positive (> 10 years, ideally lifelong)

Without treatment:

With treatment:

Infection HIV-positive AIDS Death (approx. 5–10 years)

Today‘s treatment possibilities are diverse and have continuously improved over the past years. However, a HIV infection is not able to be cured. Through a timely, lifelong therapy with modern drugs the outbreak of AIDS can in most cases be prevented.

HIV infected person

Understanding HIV:WHAT IS THE GOAL OF THE HIV THERAPY?

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The goal of a lifelong HIV therapy: To protect the defence cells in the body against the HI viruses and to thereby prevent the outbreak of AIDS.

Medicinal products establish a protective shield against

the HI viruses

Protective shield reducesthe number of HI viruses.

Immune defence remains intact

many HI virusesHIV infected person few HI viruses

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In many cases the number of viruses (Viral Load = VL) decreases so substantially thanks to therapy that they are no longer able to be detected with today‘s blood tests. A no longer detectable viral load does not mean that one is no longer HIV-positive. The disease how ever is then under good control and the transmission risk for the partner is much smaller.

Regular blood tests are important for all individuals who are HIV-positive. The tests measure how many immune cells (CD4 cells) and how many viruses (VL) are contained in a drop of blood.

Understanding HIV:WHAT DO CD4 CELLS AND VIRUS LOAD (VL) MEAN?

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Progression under optimum therapy

Therapy success

Immune cells CD4 increase

Immune cells CD4 high

Viruses VL decrease

Viruses VL low

• With medication intake: more immune cells, less viruses

• Protective shield improves

Start of therapy

Regular intake of the tablets

• With regular medication intake: many immune cells, few viruses

• Protective shield is intact

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Important: A positive HIV test does not in all cases mean the immediate start of an HIV therapy. The regular check-up of the health status by the doctor is however necessary. The doctor then together with the patient decides when the medication should be started.

Typical therapy procedure with HIV infection

Positive HIV test Regular check-ups with the doctor Therapy preparation

Attending to a healthy way of living: • balanced, healthy nutrition• suffi cient exercise• abstaining from cigarettes/alcohol/drugs• preventing excessive weight

• monitor CD4 cells/viral load (VL)

• discuss start of therapy with the doctor

• clarify questions

Determination of the CD4 cells and the Viral Load

(VL)

Understanding HIV:WHAT IS THE PROCEDURE AFTER A POSITIVE HIV TEST?

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Start of the combination therapy

Therapy Therapy success

With regular intake of the tablets (always at the same time

every day) there is a good life expectancy. In normal cases

AIDS can be prevented.Irregular or

forgotten intakeChange of therapy

But: Selection of medication is limited; The replacement can not

be repeated endlesslyHI viruses become

resistant to one/several active substances

Warning! Can negatively infl uence the therapy.• grapefruit • other medicines • alcohol • drugs

Important to note

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Important: An HIV infection is usually treated with a combination therapy consisting of several antiretro-viral drugs, the so-called highly active antiretroviral therapy (HAART). This consists of the simultaneous application of usually three active substances from different classes of medicinal drug.

So the viruses are combated at different locations and they are pushed back. The viral load becomes reduced.

Where does the medication attack the HI viruses?

Protease

Enzymes(metabolism catalysers)

Virus RNA

Reversetranskriptase

Integrase

CD4HIV

HIV

InfiltrationStructure HI virus

HI viruses penetrate into the immune cells (CD4 cells).So-called entry inhibitors (EI) prevent the penetration of the HI virus into the CD4 cell.

The HI virus belongs to the retroviruses. It can only multiply if it infiltrates into a human cell.

Understanding HIV:HOW DO HIV DRUGS ACT IN THE BODY?

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CD4Virus DNA

Virus RNA

RT

Copy of the virus RNA

With the help of the enzyme „Reverse Transcriptase“ (RT) the virus RNA is transformed to DNA (copied). This is the prerequisite for the incorporation into the human DNA.Nucleoside/Nucleotide analogues (NRTI), and non nucleoside analogues (NNRTI) inhibit the „Reverse Trans-criptase“ and thereby the transformation of RNA into DNA.

CD4Virus DNA

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Incorporation of viral genetic material

The DNA copy of the viral genetic material is incorporated into the human DNA.Integrase inhibitors (II) prevent this incorporation.

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Production virus particle Release of new HI viruses

The CD4 cell starts to produce virus material, which is sub-sequently broken down into the right building blocks through the viruses own enzyme „Viral Protease“ (VP).Protease inhibitors (PI) prevent this process. It is no longer possible to produce functional viruses.

Without medication the infected CD4 cells continuously produce new infectious HI viruses. These are transported out of the CD4 cell and attack further CD4 cells.

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Short-term side-effectsUsually temporary at the beginning of a therapy

Important: Most side-effects occur at the beginning of the therapy and often subside again by themselves. You should nevertheless be observant and report the side-effects to your doctor. In certain cases alleviating medication can be used. Otherwise the therapy will require being changed.

B PsycheSleep disordersNightmaresDepression

C Stomach/intestinesDiarrhoeaNauseaVomiting

A HeadHeadacheFatigue

D SkinRashes

Understanding HIV:WHICH FREQUENT SIDE-EFFECTS CAN OCCUR WITH AN HIV THERAPY?

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Short-term side-effectsUsually temporary at the beginning of a therapy

Long-term side-effectsOnly become apparent over the course of a therapy

H BloodHave cholesterol/blood glucose levels regularly checked

G StomachFat deposits (lipodystrophy)

E EyesYellow colouring

F Liver/Kidneys/BonesUndergo regular check-up examinations

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If the medication intake is forgotten or missed out then resistances can form and the medication can become ineffective.

Important for all HIV drugs:• exact dosing• correct time of intake

Amount of active substance in the body decreases

night morningduring the day evening

Amount of active substance in the body decreases

Repeated medication intake

necessary

The next dose needs to be taken before the last dose has been completely excreted.

Example: Intake morning and evening

Understanding HIV:WHY IS THE REGULAR INTAKE OF THE MEDICATION SO IMPORTANT?

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What happens if I do not take the medication regularly?

New medication combination is required

A new medication combina-tion may possibly have more side-effects and/or be less

convenient to take.

HI viruses increase and become resistant

Medication becomes

ineffective

Irregular medication

intake

Disease progresses.

Virus spreads. Danger of infection increases.

The selection of medication

combinations is limited.

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NOTES

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NOTES

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Understanding HIV:MYMICROMACRO – FROM MACRO TO MICRO

There is still a lot of uncertainty and need for information regarding HIV and AIDS.

The available information on the topic of HIV is increasing day by day – a macrocosm of facts and opinions. Anyone looking for answers on the Internet is confronted with a vast wealth of information. Thereby often only a fraction is relevant for the specific person – the individual microcosm.

With the web portal MyMicroMacro Janssen has undergone a commitment to people with HIV and their next of kin, and to improving their living and care situation.

Here affected or interested individuals can quickly and simply receive answers for their very specific personal questions.

MyMicroMacro is as micro or as macro and as individual as the individual needs. As special as every life situation, every disease progression and every therapy!

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Understanding HIV:FINDING ANSWERS AND HELP – INDIVIDUALLY AND COMPLETELY PERSONALLY

The direct way to obtain the searched information After anonymous entry of some data about the personal life situation the information offer at is sorted and becomes more specific. From the greater to the smaller. From generalities to what is personal and specific.

In your complete personal interestsThe intelligent content filter increasingly adapts the page step-by-step to the interest profile of the visitor: For example different content is provided for an HIV-positive homosexual man than for a heterosexual woman, who after a risk contact is fearful about a possible infection.

This is what individuality looks like The more detailed the data in the input filter, at the same time the more refined the offering and information becomes for the user.

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Janssen-Cilag GmbH

Johnson & Johnson Platz 1 41470 Neuss Germany

www.janssen-deutschland.de

Finding answers and help – individually and completely personally

• My content with individual informationon HIV and AIDS

• Specific questions and answers in theexpert’s forum

• Address finder with specialised therapists,pharmacies and information centres

• Important dates related to HIV/AIDSin Event Calender

iMR

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