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Choosing the Right Combination For You

Being newly diagnosed with HIV, even though you may have been infected for quite some time, doesn’t necessarily mean that your doctor will start you on an HIV therapy regimen immediately. It is extremely important that once diagnosed, you see an HIV specialist. A doctor who specializes in the treatment of HIV will give you the right tests, ask the right questions, be informed on the latest treatments and combinations and start you out on the right path to your successful HIV treatment.

There are a few factors to consider before starting treatment and tests you’ll be given to help with the determination. HIV progresses very slowly. It can take 10-years or more, depending on the individual and again other factors, for HIV to progress to AIDS without treatment.

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. HIV can become resistant to your regimen if you don’t adhere to it and while there are other regimens, there are only so many.

You’ll most likely start out with a basic clinical assessment. This assessment is good because it can determine other existing medical conditions, medications you are currently taking and other factors that can help in making your first shot at a regimen an effective and trouble-free one.

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 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. Different doctors have different opinions concerning when to start so listen to your doctor’s advice, he will know your individual profile and needs.

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 those have greatly decreased these days. Today’s drugs are numerous, tremendous, easy to take, easy to tolerate, easy to adhere to and most of all highly effective.

There are currently 37 FDA approved drugs for HIV treatment, including multi-class combination drugs. The combination drugs (some of which have been around for years while a couple 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:

2 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) plus 1 Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
2 NRTIs plus 1 Protease Inhibitor (PI)
2NRTIs plus 1 Integrase Inhibitor (II)

So while it’s tremendous to have choices for your initial treatment, how can you choose the right combination for you?
First, listen to your doctor’s recommendations. But, don’t hesitate to state concerns and ask questions. Your doctor doesn’t know everything about you. Next, do your homework before you start. Learn as much as you can about the recommended therapy and find out if you think it will work for you – long-term. Here are a few considerations to check out:

1 Drug Resistance

As you may know, there are different strains of HIV. There are tests that can and should be given to see if your strain is resistant to a certain class of drug. Even after your initial treatment combination, resistance can be transmitted. This is one reason why continued monitoring is important. If you acquire a transmitted resistance, your current regimen can fail to be effective against a new strain of HIV.

2 Pharmaceutical, Recreational and Herbal Drug Interactions

Interactions between various prescription drugs, recreational drugs and even herbal supplements can cause your regimen to be less effective or fail. This can be due to a lack of absorption or interference with your HIV medications. Make sure you consult your doctor about even herbal supplements that you are taking or might be considering taking and be honest about any and all recreational drugs and alcohol consumption.

3 Food Restrictions

HIV medications are to be taken as prescribed. There are some HIV medications that should be taken with food or a meal to increase their effectiveness and also lower potential side effects. Be sure to let your doctor know if you have a job or lifestyle that won’t allow you to take meals or food as prescribed.

4 Adherence

Adherence – sticking with your regimen – is extremely important! The rule is that you should be 95% or better at taking your medications as prescribed. If you fall below that, you risk drug resistance. Make sure you choose a combination that you can stick with. With the many single-pill regimens available today, adherence is not nearly the problem it used to be.

5 Pill Size And Pill Burden

HIV medications come in many different shapes and sizes some pills are very large. Also, the pill burden, or number of pills to be taken throughout the day, can be numerous. Some people have a hard time swallowing larger pills and some have trouble remembering when and what to take. This effects your adherence so let your doctor know if you have problems with these issues.

6 Side Effects

All HIV drugs have been tested through many clinical trials and they all have known side effects. That doesn’t mean that you will absolutely have to deal with a particular side effect but it also means that you may have one not stated. This may be something that you can’t deal with for whatever reason or it may be something that can be treated. Study known side effects of the combination you are about to choose. You can do this by going to any drug website or looking at the many Direct To Consumer (DTC) ads. Definitely let your doctor know about the side effects you are concerned with.

7 Affordability and Financial Concerns

You’re going to live a long life and to this point anyway, you’re going to be taking your meds for the rest of your life. HIV medications are expensive but there is a lot of help if you know where to look. Check with your insurer, your state’s ADAP, Patient Assistance Programs (of pharmaceutical companies) and Prescription Assistance Programs to name just some of the help out there. You’re going to want to make sure that your choice is covered and any out-of-pocket expense that you might be looking at is something you can live with over the long haul.

8 Lifestyle and Changes to it

Are you pregnant or planning on becoming pregnant? Are you planning to move out of state or think that might be a possibility someday (which is important if you are ADAP qualified)? Do you enjoy drinking alcohol regularly or are you involved in recreational drug use?

Try to think about your life and any changes that may occur – good and maybe not so good, that could affect your meds and adherence in the future. Next, be honest with your doctor about any lifestyle issues that might affect the performance of your combination if you feel you’re unwilling to change them.

These are just a few things to think about when you choose a combination therapy that is right for you. You’ll probably have others to add to the list but the more questions you ask and the more research you do, the more likely you’ll be to make your first choice a successful one.


 

 

 

 

 

 

 

 

 

 

 

 



Copyright 2015, 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!