Considering HIV Treatment
Are you Ready?
Treatment with HIV drugs can improve quality of life and help people living with HIV (HIV+ people) stay healthier longer. But starting treatment is a big decision. In order to get the most benefit from HIV drugs, they must be used just the way they are prescribed. Taking your treatment correctly is as important as which drugs you and your doctor choose. So before you get started, make sure you are ready to commit to taking your HIV drugs the right way, every day for your own health! This takes a combination of the right health care provider, enough knowledge about HIV, and a positive attitude.
You and your health care provider are a team working together to make the best treatment decisions for you. Ask yourself a few questions: Do I have confidence in my provider? Can I be totally honest with him or her? Is he or she available when I have questions? Does he or she take my concerns seriously? If so, great!
If not, try to make changes. Write down the questions you’d like to ask your health care provider before you go to visits. It’s important to answer your provider’s questions with the truth, not with what you think the she or he wants to hear. If that still doesnt work, it may be time to find another provider.
It is also wise to have a health care provider who is an HIV specialist. Health care providers who devote most of their time to HIV are best able to manage this complicated condition.
Knowledge about HIV
HIV is a virus that infects and destroys CD4 cells. CD4 cells are part of the body’s immune system. The immune system protects the body from invaders. When the immune system loses too many CD4 cells, it becomes weak and is unable to fight off germs. At this point, you are at risk of getting AIDS-related opportunistic infections (OIs) that can cause serious illness or death.
Scientists have developed drugs that block HIV from reproducing (multiplying). These drugs are grouped into classes. Each class of drugs works to stop HIV at a certain point in its life cycle. So far there are five classes of drugs:
- Entry inhibitors (includes fusion inhibitors and CCR5 antagonists)
- Integrase inhibitors
- Nucleoside/nucleotide reverse transcriptase inhibitors (nukes or NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (non-nukes or NNRTIs)
- Protease inhibitors (PIs)
HIV drugs are always used in combination to attack the virus at different points in its life cycle. This usually means using drugs from at least two classes. Combining HIV drugs is the best way to reduce the amount of HIV in your blood (viral load).
Baseline Blood Tests
Before you start HIV treatment, your health care provider should have you take a number of blood tests. These are your baseline tests. Future test results will be compared to your baseline results to check how you are doing and how your treatment is working.
- CD4 cell (T-cell) count: The CD4 count checks the strength of your immune system. After you start HIV treatment, you should see your CD4 count go up. Your CD4 count should be checked every 3-4 months, if possible.
- Viral load test: The viral load test measures the amount of HIV in your blood. After you start HIV treatment, you should see your viral load go down. Your viral load should be checked about a month after you start or change HIV drugs. After that, it should be checked every 3-4 months.
- Resistance test: The resistance test helps determine which drugs are likely to work for you. Experts recommend that everyone should get a resistance test before starting or changing HIV treatments, even if you do not plan to start HIV treatment for a while.
- Other tests to check your overall health: These include complete blood count (CBC), chemistry screen, lipid profile, and glucose. Your health care provider should talk with you about how often these tests need to be done.
- To get your viral load as low as possible for as long as possible
- To preserve or improve the health of your immune system by increasing your CD4 cells
- To improve your quality of life and reduce illness and death
The government has put together a list of guidelines to help people decide when to start treatment:
- Anyone with a CD4 count less than 350 should start HIV treatment
- If you are in one or more of the following situations, you should also start HIV treatment, no matter what your CD4 count:
- You have or had symptoms of AIDS (such as OIs)
- You are a pregnant woman
- You have HIV-related kidney disease
- You need treatment for hepatitis B (HBV)
- HIV treatment is recommended to be started in anyone with a CD4 cell count between 350 and 500
Your readiness to start and stick to treatment is also an important factor. Talk to your health care provider to make sure you understand the importance of adherence (see below) and to make a plan to address any barriers to adherence before starting.
Some experts feel that it is a good idea to start treatment earlier with a CD4 count above 350 and no symptoms. There are risks and benefits to doing this.
Benefits of Starting Early:
- Maintaining a higher CD4 cell count
- Preventing further damage to the immune system
- Decreasing risk for HIV and non-HIV health problems
- Reducing your risk of transmitting HIV to others
Risks of Starting Early:
- Experiencing drug-related side effects, including possible long-term side effects not yet known
- Developing drug resistance (see below), which can reduce future treatment options
- Having to be on treatment for a longer time
Whenever you start treatment, you need to take your drugs on schedule. This is called adherence. In order to get the maximum benefit from HIV therapy, good adherence is required. This is because HIV drugs need to be kept at a certain level in your body to fight the virus. If the drug level falls, HIV may have a chance to fight back. Skipping doses, not taking the drugs on time, and not following food requirements can all cause your drugs to be less effective or to stop working altogether.
After starting HIV drugs, you should see your viral load decrease and your CD4 cells increase. Over time, however, some people see their viral load increase, even though they are still taking HIV drugs.
When a drug is no longer able to fight HIV effectively, we say that HIV has become “resistant” to that drug. If you develop resistance, you will likely have to change some of the drugs in your regimen. If your viral load goes up while you are still taking HIV drugs, your health care provider should offer you a resistance test to find out which drugs aren’t working and to help choose ones that will. For some people with resistance to many HIV drugs, it may be difficult to find a new combination.
The best way to fight resistance is to be adherent to your drug regimen.
A Positive Attitude
If you decide the time is right to start treatment, have a good attitude going in. Believe that:
- Starting treatment is the right decision for you
- The HIV medications will help you fight the virus
- You can take your medications the right way
Whatever decision you make, don’t go it alone. Put together a support system including your health care provider, nurses, social workers, and case managers. You may want to join a support group of other HIV+ people. Family and friends can help too.
The more you think and talk about your decision, the better the outcome. Whatever you decide to do, keep going to your health care provider for regular check ups and blood work.