Considering HIV Treatment
May 5, 2015
A branch of the US government called the Department of Health and Human Services (DHHS) has put together a set of HIV treatment guidelines. The guidelines provide a lot of useful information to help health care providers and people living with HIV make decisions about when to start, when to stop, and when to change HIV medications. It also helps providers and people living with HIV choose among the many available HIV drugs.
The guidelines are written and reviewed regularly by a group of HIV experts, including researchers, health care providers, and community activists. The DHHS's panel of experts now recommends that all people living with HIV take HIV drugs, no matter what their CD4 count.
The World Health Organization's (WHO) treatment guidelines from 2013 suggest that people living with HIV who have CD4 counts less than 500 be treated with a combination of HIV drugs. The WHO also recommends that all pregnant women living with HIV get HIV treatment, regardless of their CD4 count. The British HIV Association (BHIVA)’s treatment guidelines, last updated in June 2014, recommend that all people living with HIV who have CD4 counts less than 350 be treated with a combination of HIV drugs. The BHIVA’s guidelines also mention several situations in which treatment should begin for people with CD4 counts above 350. This includes instances in which people with CD4 counts greater than 350 wish to start HIV drugs; the BHIVA recommends that these people have their wishes respected and begin treatment. Similarly, the BHIVA recommends that all pregnant women receive HIV treatment, regardless of their CD4 counts.
Benefits of Starting Early
Risks of Starting Early
Risks of Starting Late
When considering when to start treatment, you and your provider will also look at your overall health, and your readiness to start and stick to lifelong treatment. Talk to your health care provider to make sure you understand the importance of adherence (see below) and to make a plan to address any barriers to adherence before starting.
Whenever you start treatment, you need to take your drugs on schedule and exactly as prescribed. This is called adherence. In order to get the best benefit from HIV therapy, good adherence is required. This is because HIV drugs need to be kept at a certain level in your body to fight the virus. If the drug level falls, HIV may have a chance to fight back. Skipping doses, not taking the drugs on time, and not following food requirements can all cause your drugs to be less effective or to stop working altogether.
After starting HIV drugs, you should see your viral load decrease and your CD4 cells increase. Over time, however, some people see their viral load increase, even though they are still taking HIV drugs.
When a drug is no longer able to fight HIV effectively, HIV has become "resistant" to that drug. If you develop resistance, you will likely have to change some of the drugs in your regimen. If your viral load goes up while you are still taking your HIV drug regimen, your health care provider should offer you a resistance test to find out which drugs are not working and to help choose ones that will. For some people with resistance to many HIV drugs, it may be difficult to find a new combination.
The best way to fight resistance is to be adherent to your drug regimen.
If you decide the time is right to start treatment, it is important to have a good attitude. It can be helpful to believe that:
It may also help to get in touch with the reason you are starting treatment -- to keep yourself in good health, whether for your own sake or for the good of your family.
Whatever decision you make, it is important not to go it alone. Put together a support system that may include your health care provider, social workers, case managers, family, or friends. You may also consider joining a support group of other people living with HIV.
The more you think and talk about your decision, the better the outcome. Whatever you decide to do, it is important that you keep going to your health care provider for regular check ups and blood work.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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