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Starting HIV Treatment: Recently Asked Questions

November 29, 2016

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Credit: Alena Brozova for Hemera via Thinkstock


On TheBody.com's "Ask the Experts" forums, our team of experienced, knowledgeable HIV physicians regularly tackles a wide range of questions from people living with HIV. Many of these are questions about "first-line" HIV treatment: issues such as deciding when to start taking antiretrovirals, choosing which meds to take, dealing with initial side effects and figuring out whether a regimen is working.

Here are some of the important questions about starting HIV treatment our experts answered from January 2015 through November 2016.

Questions have been condensed and edited for clarity.


When/Why to Start

Can Meds Really Stop HIV From Ever Becoming AIDS?
I live outside the U.S., but have seen Charlie Sheen's case reported in the media. One of the famous doctors in my country said on TV that taking antiretrovirals will cause HIV to never progress to AIDS. Is it true? Can we say never? Read the answer >>

My Body's Fighting HIV Just Fine on Its Own ... Right?
I was diagnosed back in 2009. My viral load has remained low and my CD4 over 500 during that time, and I feel great. Yesterday my doctor said that I should be on treatment anyway, but honestly I don't feel confortable with the idea. What do you think? Read the answer >>

Is a CD4 Count of 350 "Dangerous"?
Is having a CD4 count of 350 considered to be a very dangerous situation? I am not yet on meds, and I'm worried that my CD4 count is so low I may not fully recover. Read the answer >>

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Meds or No Meds, Still a Death Sentence?
I realize that, without HIV treatment, I'm at risk for all sorts of terrible illnesses and eventual death. But the way I see it, with HIV treatment I'm at risk for all sorts of terrible side effects. Isn't this a death sentence either way? Read the answer >>

I'm Not Convinced HIV Treatment Is Safe
I am HIV positive and on treatment. I am convinced that, as time goes on, I am going to suffer from renal failure, chest infections, heart problems or other organ issues because HIV drugs essentially poison my blood stream. I'm terrified of the future. Please help! Read the answer >>

Do HIV Meds Ever Simply "Not Work"?
Was there ever a case where an HIV regimen didn't work? I know there are so many types of medicines for HIV, but I've heard that some pills don't work sometimes. Read the answer >>

What if a Person Refuses to Take HIV Medications?
A member of my family was diagnosed with HIV last June. She briefly started antiretrovirals, but now she refuses to take medication or even meet with our family doctor. She smokes and binge drinks, and her CD4 count is down to 76. Is there anything we can do for her? Read the answer >>

Should I Start Treatment Before Getting Resistance Test Results?
I was infected around four months ago and, after reading about how important it is to start HIV meds as quickly as possible, I'm pushing my doctor to let me begin treatment before my resistance test results are in. (Where I live, it can take a month for results to arrive.) Do you agree this is a good move? Read the answer >>


Choosing and Tweaking Your Regimen

Choosing Between Regimens (and Their Side Effects)
I have tried two different common HIV treatment regimens, and they both have different side-effect profiles. On one, I feel bloated and gassy and my skin gets dry and itchy. On the other, I develop headaches and have trouble sleeping. How do I choose between the two? Read the answer >>

Can Two-Drug Therapy Work?
I recently read about an experimental approach to HIV therapy that involves just two drugs (instead of the three or four that are in most regimens). It seems promising to me, but what do you think? Read the answer >>

Aripla's "Fall From Grace"
I have read about Atripla (efavirenz/tenofovir/FTC) falling from grace as a recommended regimen. That's scary for some of us who have limited choice because of our geography -- being in a third-world location limits our access to safer therapies. Am I really putting myself at great risk by continuing to take Atripla (or one of its generic equivalents)? Read the answer >>

How Often Can I Change My Dose Time?
I've heard that HIV meds don't need to be taken at precisely the same time every day. But just how late can I permit myself to be with a dose? One hour? Two? Five? Read the answer >>

One Pill, Hold the Sustiva
Are there any once-a-day antiretrovirals available that don't contain Sustiva (efavirenz, Stocrin)? Read the answer >>

First-Line Therapy: Fixed-Dose Combo Plus Protease Inhibitor?
I have not yet started taking meds. I have an emtricitabine (Emtriva)-resistant strain. My doctor prescribed Triumeq (abacavir/dolutegravir/lamivudine) and Prezcobix (darunavir/cobicistat). Is it unusual that my regimen will consist of a fixed-dose combination drug in addition to a protease inhibitor? Read the answer >>


Side Effects

Look at These HIV Drug Side-Effect Lists! The warning labels on many HIV drugs seem to be filled with information about potentially serious side effects. If these are drugs are supposed to help me, then why are they so dangerous? Read the answer >>

Today's Risk for Body Shape Changes
I know that several factors are involved but, as a general rule, what percentage of people who start HIV treatment in the U.S. with one of the currently recommended combinations will develop obvious fat or other physical changes in their first 10 to 15 years of treatment? Read the answer >>

Will My Meds Destroy My Organs?
Can someone please tell me if my HIV treatment regimen will seriously damage my liver or other organs? I'm so worried. Read the answer >>

Why Did I Develop an AIDS-Related Illness After Starting Treatment?
I was diagnosed positive in January 2007. Due to fear, I didn't begin treatment the way I should have, and I finally began taking Atripla this past April. What concerns me is that, within a month of starting treatment, I developed a form of tuberculosis that has required surgery and additional meds to treat. I'm discouraged and a little scared; do you have any advice? Read the answer >>

Starting Meds and Frustrated by Side Effects
I was diagnosed last month and was fortunate enough to start treatment very quickly. I started on Atripla, but my doctor quickly switched me over to Stribild (elvitegravir/cobicistat/FTC/tenofovir) due to rashes and neurocognitive side effects. On Stribild I have felt better, but still get rashes and a tingling feeling in my hands. I'm getting very frustrated. Are there other options I should discuss with my doctor? Read the answer >>


Success and Failure

Why Hasn't My CD4 Count Budged Yet?
In February I was diagnosed with HIV. My CD4 count was 97. I was immediately given antiretrovirals. Three months later, they took another blood test and my CD4 count was down to 84. Should I be worried? Read the answer >>

Shouldn't My Viral Load Be Gone by Now?
I was diagnosed with an HIV viral load of 569,700. I started treatment, and at first it dropped very quickly, but now it's dropping much more slowly. After five months, it's still not undetectable. I'm so worried and anxious! Read the answer >>

Just Started Treatment; Why Is My CD4% Down?
I started HIV meds at the beginning of January. I started with a CD4 percentage of 21%. I got my first labs since starting meds and, although my CD4 count went up, my percentage dropped to 16%. What's going on? Read the answer >>

Too Soon for Resistance Fears?
I was diagnosed positive in March. My first HIV genome test showed no resistance, and I started treatment. I've been 100% compliant, but my latest viral load test was slightly higher than the previous one, going up from 145 to 220. I'm very concerned that I'm developing resistance too early in the game. Should I worry? Read the answer >>

Undetectable in Two Weeks: Realistic?
Why did my HIV viral load become undetectable only two weeks after I started taking meds? From what I knew, I thought it was supposed to take four to six months to get to that point. Read the answer >>

Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com.

Follow Myles on Twitter: @MylesatTheBody.


Copyright © 2016 Remedy Health Media, LLC. All rights reserved.


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