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If you get an HIV positive diagnosis, even though you may have been infected for quite some time, it doesn’t necessarily mean that you will start on an HIV therapy regimen immediately. HIV progresses very slowly. It can take 10-years or more, depending on the individual and other factors, for HIV to progress to AIDS without treatment. But YOU don't want it to get to that point. One of the most important things you can do after you receive an HIV diagnosis is to begin seeing a doctor. Make sure the doctor you choose is an HIV specialist so they are current on all of the new treatments and trends. He or she can begin monitoring your body and your HIV. Seeing a doctor regularly will help assure you’ll start treatment when the time is right.

What to expect:
What to expect from your doctor visits:
When you see your HIV specialist, you’ll most likely start out with a basic clinical assessment. This assessment will measure where you are with regard to your HIV virus status, can determine other existing medical conditions, check medications you are currently taking to consider potential drug interaction problems and other factors that can help in making your first shot at a regimen an effective and trouble-free one. This is also a good time to make sure you have a good rapport with the doctor and his staff.

Your doctor will work with you on an individualized regimen that will be based on many of the following factors:

• Pre-existing physical conditions, ailments and diseases
• Potential adverse drug effectsPotential drug interactions
• Gender and if you are pregnant or planning to be
• Drug resistance testing
• Your CD4 count Adherence ability
• Lifestyle and convenience issues such as pill burden (amount of pills) and frequency of dosing.

Determining when you’ll start treatment
The one test that you’ll be given which will more than anything else determine clinically when you should start therapy is a CD4 test.

The CD4 test measures your CD4 T-cells or just “T-cells.” Your T-cells play an important part in the immune system and HIV, as time goes on, destroys them. The average person without HIV has between 500 and 1200 T-cells (which are measured within a cubic millimeter of blood). When your T-cells drop below 200 or when you have an opportunistic infection, you are considered to have AIDS.

The World Health Organization (WHO) guidelines earlier (2006) gave the 200 T-cell mark as the point to start treatment. This is still a starting point in some developing countries. Now, however, both the WHO and the United States Department of Health and Human Services guidelines recommend starting therapy at the 350 T-cell mark. This mark is before you ever have AIDS and that’s really the whole point of treatment: to keep your HIV infection from ever progressing to AIDS. Physicians do differ on starting points. Most will get you going between 500 and 350. Many physicians who recommend starting sooner do so to make sure there is no damage at all to the immune system.

The guidelines do suggest three exceptions to the 350 T-cell benchmark:
- If you are a pregnant woman, you should start HIV therapy to protect your unborn child. HIV therapy dramatically reduces the risk that you will transmit HIV to your baby. After you give birth, if you don’t need HIV therapy for your own health yet, you may be able to stop taking your meds until your T-cells drop to 350.
- If you have HIV-associated kidney disease or kidney damage, you should start HIV therapy regardless of your T-cell count.
- If you have Hepatitis B virus that requires treatment, as well as HIV, you should begin HIV therapy at the same time you start therapy for Hepatitis B, because some of the most effective drugs to treat the two diseases are the same.

Choosing your first regimen
When you and your doctor decide it’s time to start therapy, you can discuss your first combination of drugs that you’ll take – your first-line therapy.

This used to be tricky and there were terrible side-effects but that was then, back in the early days of the disease, and this is now. Today’s drugs are numerous, tremendous, easy to take, easy to tolerate, easy to adhere to and most of all highly effective.

There are nearly 40 FDA approved drugs for HIV treatment, including multi-class combination drugs and Single Tablet Regimens (STRs). The combination drugs (some of which have been around for years while a few are relatively new) are tremendous because they combine everything you need in just one or two pills that you take just once a day.

Most current regimens for people just starting HIV treatment consist of three drugs from these classes which make up the HIV cocktail. Combination drugs and STRs, that we've mentioned, combine two or more of these drug classes into a single pill.

2 NRTIs plus 1 NNRTI
2 NRTIs plus 1 PI
2NRTIs plus 1 II

More information about the newest and preferred HIV drugs, preferred treatment regimens and current guidelines can be found in the 15th Annual HIV Positive! magazine Treatment Guide being published in April or you can go to the U.S. Department of Health and Human Services website at http://www.hhs.gov, the U.S. Food and Drug Administration website at http://www.fda.gov and our website at http://www.hivpositivemagazine.com.

What to consider
Take advantage of what your local ASO has to offer:

Most AIDS Service Organizations can give you everything from simple advice to in-depth clinical counseling. They also can advise you on specialists, if you don't already have one and what federal, state and even local programs you may be eligible for.

Get your mind right
One very important personal factor to keep in mind when you start treatment is to make sure your mind is right. You’ll be on therapy for the rest of your life once you start and adherence (taking your meds 96%-plus on time every time) is key. If you have any sort of drug or alcohol dependency or suffer from any kind of depression that might interfere with adherence, let your doctor know and take the steps to recovery before you start HIV treatment. HIV can become resistant to your regimen if you don’t adhere to it.

Your finances, insurance and future
Your HIV regimen will need to be taken, at least at present, for the rest of your life. And, you more than likely have options for your first regimen. HIV medications are all expensive so make sure that what you decide to take, you can afford both now and in the future. The ACA/Obamacare has made insurance available but it may not be exactly affordable due to insurance companies putting HIV meds on top tiers of their plans and making those plans still very expensive. ASO case managers can be of help with eligibility for some programs and they are aware of other programs offered by pharmaceutical companies.

Also, if you are eligible for an AIDS Drug Assistance Program (ADAP) in your state and the medication(s) you will be taking are covered but think you may be moving to another state in the future, make sure the medication is covered and you are eligible for ADAP in the state you might be moving to.

Copyright 2018, Positive Health Publications, Inc.

This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!