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Is Your HIV Treatment Working? Warning Signs and False Alarms

Last Reviewed: May 29, 2013

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Look Into the IRIS: People who start treatment at low CD4 cell counts (particularly when it's below 200) might suddenly experience a whole array of symptoms: fever, swollen lymph nodes, congested breathing and other symptoms that you might feel if your body was reacting to a bacterial or viral infection.

In fact, that's likely exactly what's happening: What you're experiencing may well be Immune Reconstitution Inflammatory Syndrome (IRIS). IRIS is a sign that the medications you're taking are helping out the immune system, and as a result your body is now able to recognize and mount a response to invaders that have been taking advantage of your weakened state. Although IRIS might make you feel worse at first, once your recovering immune system fights off the infection you'll start to feel much, much better than before you started treatment.


However, if you develop symptoms of IRIS, it also means your doctor should be involved. This is because extreme cases of IRIS can cause you to get very sick and sometimes require hospitalization, which will let your doctor provide close monitoring and support until you recover.

Watching the Horizon: After a while on treatment, you might find that you're experiencing a side effect you didn't notice before, or that bothers you now more than it used to. For instance, maybe you started taking Atripla and discovered over the course of several months that your sleep isn't that great or your mood has slipped.

There are also still plenty of unanswered questions about the long-term effects of HIV medications. We know that they are lifesavers in terms of preventing HIV from killing you; what we're still learning is what price you may have to pay for a much longer, generally healthier life. Be sure to stay in touch with your doctor about some of these potential long-term health issues, and use as a resource to stay educated about side effects and other problems that people with HIV get as they grow older.


The Bottom Line: If you find yourself not feeling well days, weeks or months after you've started HIV treatment -- particularly if that feeling isn't going away or is getting worse -- the question quickly becomes, "Do I want to try to find ways to manage this symptom, because my regimen is working and I'm able to keep up with my meds every day? Or do I want to see what a new regimen may have to offer, both good and bad?" This is a very individual decision, one best made thoughtfully and carefully after discussion with your health care provider.

It can be nerve-wracking to start an antiretroviral regimen. Fortunately, the fear of what might happen is often worse than what actually happens. In fact, many people feel better after they start HIV treatment: They feel better physically because the medications are stopping the unchecked replication of HIV in your body and helping your immune system recover. And they feel better emotionally because, well, they feel better physically -- and because many of the fears they had about HIV treatment didn't come to pass.

Still, the key for anybody beginning treatment is to be aware of these potential warning signs, educate yourself about their causes and solutions, and talk openly with your health care provider about your concerns and your options. This will help ensure that your treatment remains on track no matter what obstacles might pop up in your way.

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