HIV 101














What Everyone Should Know
About HIV Treatment

If you have just been diagnosed with HIV, you're probably anxious about it-to say the least! You've heard horror stories. You may well be afraid that you're about to die.

Calm down. It's not as bad as you think. There is treatment available today that can help you live a long, happy, productive life with HIV. You're not going to die.

It's true that there is still no cure for HIV. There is currently no way to eliminate the virus from your body completely. But there are medications available that can keep the virus under control indefinitely. Take your HIV medications faithfully, and you have an excellent chance of living out a normal life span, or something very close to it.

It wasn't always that way.

In the beginning, HIV almost always progressed to AIDS over time, and, ultimately, it was a death sentence.

The first glimmer of hope came on March 19, 1987, when the Food and Drug Administration (FDA) approved the first-ever drug designed to combat HIV: Retrovir, more commonly known as AZT.

As the years went by, more HIV drugs were introduced. In late 1995 and 1996 there was a real breakthrough. Scientists discovered that combining three HIV drugs into a treatment "cocktail" could stop HIV in its tracks. This approach was called "HAART"-"Highly Active Anti-Retroviral Therapy"-and it was a lifesaver. HAART is still the basis for HIV treatment today.

Since then, HIV drugs have gotten better and better: more effective, easier to take, and easier to tolerate. Many of the early drugs, hailed as "miracles" in their time, have become obsolete because the new drugs are so much better. People used to take 30 pills a day to control their virus. Today, for many people who are newly diagnosed, it is possible to control HIV with just one pill, taken just once a day.

However, there still is no cure for HIV. The drugs available can keep your HIV from reproducing, but they cannot wipe it out. Once you start taking the drugs, you have to keep taking them for life. Even if your viral load is "undetectable," if you stop taking the drugs, the virus comes roaring back.

Still, the change is remarkable. Today, HIV is a chronic manageable disease, similar in many ways to type 1 diabetes (and much easier to manage!) No one lives forever, but most people living with HIV today will probably die of something else.

This issue of HIV Positive! magazine includes a complete list of every medication approved by the FDA for the treatment of HIV. It's in plain English, and we call 'em like we see 'em. We encourage you to read it, and discuss your options with your doctor.

When Should You Start Treatment?

You might think that, with such a dangerous disease, you should start to treat it right away. But that's not necessarily the case. HIV progresses very slowly. It can take as long as ten years for HIV to progress to AIDS without treatment.

Also, once you start taking HIV medications, you have to take them for life. These are powerful drugs, and even the very best of them have some side-effects. So you don't want to start taking them too soon. Obviously, you also don't want to start taking them too late.

Expert advice on when you should start treatment has always been based on your "T-cell" count, rather than the length of time you've been infected.

Your T-cells-called "CD4 T-cells" in full-are immune system cells that are attacked and killed off by HIV. So a declining T-cell count is one of the most reliable signs of advancing HIV. (The other barometer doctors use is an increasing "viral load.") When your T-cells drop below 200 cells/mm3, or when you have an "opportunistic infection," you are considered to have AIDS.

Until recently, HIV treatment guidelines suggested that you should wait to start HIV treatment until your T-cell count dropped below 350 cells/mm3.

However, at the most recent "Panel on Antiretroviral Guidelines for Adults and Adolescents" convened by the Department of Health and Human Services, 55% of the experts strongly recommended starting treatment when your T-cell count drops to 500 cells/mm3. In fact, 50% of the experts recommended starting even earlier-when your T-cell count is still above 500.

The reason for the change? Today's HIV medications are much less toxic and much easier on your body. So most doctors now believe the benefits of starting medications early outweigh the dangers.

How do you know when your T-cells start dropping? You should be seeing an HIV doctor and having your T-cell count tested regularly, even if you are not on medications yet and even if you are feeling great.

Other Ways To Protect Your Health

If you are HIV-positive, of course, the first thing you should do is deal with your HIV. Find a doctor who is experienced in dealing with HIV. HIV treatment is very complex and it changes all the time. Make sure your doctor is an HIV specialist!

Even if you're not on HIV medications yet, you need a doctor right now to monitor your viral load and T-cell count. Even though you may be feeling fine, you should have your viral load tested every 3-4 months, and your T-cell count measured every 3-6 months.

When you do go on medications, make sure you take them faithfully! Today's HIV medicines are much easier to take and much more tolerable than the medications available just a few years ago. But they don't work unless you take them! Missing doses can result in drug resistance. So be sure to take your meds on time, every time.

But there are additional things you need to do to protect your health. For example:

Get in shape.

The health benefits of regular exercise are literally too many to list. Here's just a sample: exercise reduces your risk of several major diseases, including heart disease, diabetes and several kinds of cancer. It can help protect you from osteoporosis by increasing your bone mineral density. (Osteoporosis is sometimes a problem for people on long-term anti-HIV treatment.) Exercise is one of the best ways to prevent and reverse lipodystrophy, the changes in body fat distribution that affect some people with HIV. And exercise helps lower both your blood pressure and your cholesterol level. (Elevated cholesterol is a problem for many people on HIV medications.)

What kind of exercise should you do? Ideally, a combination of aerobic exercise, like walking, jogging or bicycling, resistance exercise or weight training, and stretching.

However, almost anything you do will help! Find a sport or activity you enjoy. The key is to keep at it, and the more fun your chosen activity is, the more likely you will!

Keep an eye on your heart.

The number one health problem and leading cause of death in the United States is heart disease, so it's important for everyone to do what they can to protect their heart.

If you're on HIV meds-especially if you're on a regimen that includes a protease inhibitor-ask your doctor for a complete cholesterol check, which is also called a "lipid panel." Some HIV medications can raise your LDL ("bad cholesterol") levels along with your triglycerides-another fatty substance in the blood which can contribute to heart disease. If your cholesterol and triglycerides are high, your doctor may prescribe a class of drug called "statins" to help bring them down. In any case, you can help keep your cholesterol under control by learning about nutrition and eating a diet that is low in saturated fats and high in fiber. Exercise also helps keep your cholesterol levels under control.

Eat a healthy diet.

Good nutrition is important for everyone. Experts strongly recommend eating more fresh fruits and vegetables, and more whole grains-and less saturated fat and transfat.

Of course, we all know that broccoli is good for you and potato chips are not. But if you really want to be healthy, you need to learn more about nutrition than that-and you need to act on what you've learned.

Don't Smoke.

The dangers of smoking are well-documented-and all the things cigarettes do to healthy people, they do to people with HIV faster. So, if you smoke, stop. If you don't smoke, don't start.

Good health is in your hands. Find yourself a good HIV doctor, take your HIV medications without fail, get some exercise, watch your cholesterol, eat right-and you have a good chance of out-living your HIV-negative friends who smoke and don't take care of themselves!

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!