A little history...
HIV treatment has come a long way in a very short time. In late 1995, scientists developed the first treatment protocol that actually worked. They discovered that using a “cocktail” of three HIV medications in combination could keep people with HIV alive indefinitely. Technically known as “HAART” – “Highly Active Anti-Retroviral Therapy” – this approach is still used in HIV treatment today.
Although the general approach is the same, the medicines involved have improved tremendously since 1995! When HAART was first introduced, people had to take pills by the handful, on a strict (and sometimes bizarre) time schedule – some with food, some without. And some of the pills they took had very unpleasant side-effects. Over the years, researchers have developed better and better HIV meds, and some of the older medications have been improved.
Some medicines have been combined together so you can take two – or even all three – of the meds in your “cocktail” in one pill. Today it is possible to control your HIV with just a single pill, taken just once a day.
What should I do first?
Find a doctor who specializes in treating people with HIV. Don’t be somebody’s first “guinea pig”! HIV treatment is very complicated and fast-changing, and you need a doctor with HIV experience and expertise. Your local AIDS Service Organization (ASO) can help you find someone who specializes in HIV. If you live in a rural area, it may be worth your while to travel to the nearest HIV specialist for your doctor’s appointments – even if it’s a long way.
You need to start seeing a doctor now – even if you don’t start taking the medicines right away. Your doctor will regularly monitor two “markers” that indicate how your HIV is progressing. One is your “CD4 T-cell count” – often just called your “T-cells.” The other is your “viral load.”
T-cells are immune system cells that help your body fight off infection. HIV attacks these cells and destroys them. By monitoring your T-cells, your doctor can tell you how far your HIV has progressed, and help you decide when to start taking medications. You want your T-cell count to be high. When your T-cell count drops below 200, you are considered to have AIDS.
Your viral load is how many copies of the HIV virus you have in your body. This is another way your doctor knows how far your HIV has progressed, and how your medicines are working. You want your viral load to be low – ideally, too low for the test to detect any copies of the virus in your body at all.
When should I start taking medications?
Experts are divided on the issue of when you should begin taking HIV medicines. Some say “the sooner the better.” Others believe you should hold off if you were just recently infected and your T-cell count is still above 500.
However, experts generally agree that you should start taking meds immediately if:
- You have had an AIDS-defining illness
- Your T-cell count is below 500
- You are a pregnant woman. (In this case, the reason is to protect your unborn child. Taking HIV medications greatly reduces the chances that your baby will be born with HIV.)
What medications should I start with?
As you can see from the “Review of Medications” on the following pages, there are a lot of medications to choose from today. However, some are better than others, and only a few different options are recommended as “preferred” by the panel of HIV experts convened by the Department of Health and Human Services (DHHS). Your doctor will probably recommend one of these preferred regimens.
Your doctor will also order a drug resistance survey to find out if the strain of HIV you are infected with is resistant to any drugs. That way you can be sure you’re starting out with a set of drugs that will be effective against your HIV.
What can I expect when I start taking medications?
HIV meds cannot eradicate the virus from your body. But they are very successful in suppressing it to the point that it can’t harm you. HIV medications generally suppress your viral load to the point that it is “undetectable” in 12 to 24 weeks after you start your regimen, although it takes longer in some patients.
Once you start taking HIV medications, you have to keep taking them for life. If you stop, your HIV comes roaring back. You can also expect to see your doctor regularly to have your viral load checked (and, slightly less frequently, your T-cell count) to make sure the medications are working. Your goal will be to keep your viral load consistently undetectable, although isolated “blips” up to 200 copies per mL are common. They’re not a cause for concern – a small “blip” may just be caused by “assay variability,” meaning variations in the test itself.
What you must do.
You play an important role in your own HIV treatment. Your doctor can prescribe your meds, but you are the one who will take them. And it is vitally important that you take your meds faithfully. The current generation of medications is much stronger than the first generation, and the new meds stay active in your bloodstream longer. So if you accidently miss a single dose, it’s not as critical as it used to be. But if you miss several days or weeks, you’re asking for trouble. HIV is a tricky virus, capable of mutating into a form that is resistant to the medications you take. Strict adherence is the way to keep that from happening. If you have any side-effects or other issues that tempt you to stop taking your meds, talk to your doctor before you quit. He may be able to prescribe an alternative regimen that works better for you.
The drugs work – but only if you take them. The number one reason why HIV drugs fail to work is simply because the patient does not take them.
Of course, in addition to taking the meds faithfully, you should also do what everyone needs to do to stay healthy: eat a healthy diet, get regular exercise, watch your weight, and don’t abuse drugs or alcohol.
Do I have a future?
Yes, you do. Before the development of HAART in 1995, HIV inevitably progressed to AIDS, and AIDS ultimately led to death. But not today! The current HIV medications can keep HIV from progressing to AIDS indefinitely. Follow your doctor’s orders, and you can expect to live a long life with HIV.
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!