Living With HIV, Living With Treatment: The Capsule Version

Human immunodeficiency virus, or HIV, is a virus that slowly weakens the immune system -- your body's defence against infections and some cancers. If you have HIV for a long time without treating it, your immune system can become too weak to fight off certain serious -- even fatal -- illnesses. At this time, there is no cure for HIV infection, and there is no vaccine that can reliably protect people from getting the virus. However, there are now dozens of treatments for fighting HIV. When used properly, these treatments can help you stay healthy and well.

Living well with HIV does not begin and end with drug treatment. Taking care of your general well-being -- by eating well, getting plenty of rest and exercising regularly -- can go a long way toward keeping you healthy, and there are countless other ways you may find to better your health. CATIE publishes practical guides on nutrition, herbal therapies and complementary therapies; we hope you'll read these and find them useful. In this guide, we're discussing the biggest weapon against HIV: the drug treatments known as antiretroviral therapy (ART).

Treatments have improved a lot since the "early days" of HIV medications in the late 1980s and early 1990s. New treatments have completely changed the prospects for people with HIV. To be blunt, in all but the rarest cases, HIV infection used to lead to illness and death. But by taking HIV treatment, most people with HIV are now able to control, or "suppress," the virus, strengthen their immune systems and fight off infections. Many experts now predict that with proper treatment and care, most people with HIV should be able to live nearly as long as HIV-negative people.

There are now dozens of anti-HIV drugs, also known as antiretroviral drugs, available in Canada. These drugs have to be taken in combination to fight HIV effectively. Sooner or later, most people with HIV have to tackle two questions: (1) When should I start HIV drug treatment? and (2) Which combination should I take?

The best time to start treatment is before you get sick from HIV and before you are at high risk of getting sick. You and your doctor will keep an eye on your symptoms and your blood tests, especially key numbers like your CD4 count. You should start treatment before your CD4 count falls too low (as we discuss in detail starting in "When to Start").

Deciding which combination of antiretroviral drugs to take may seem complicated, but most people can choose from a few simple and effective "preferred" combinations (see "Choosing a Drug Combination"). It's an individual decision that will likely depend on many factors, including the state of your health, your personal preferences and which treatments you have taken in the past.

Of course, treatment can have its downsides. Antiretroviral drugs can cause side effects and long-term complications, which can range from minor to serious. However, advances in treatment mean that many people are able to choose treatments with fewer side effects.

The success of your treatment depends on continuing to take the drugs exactly as directed every day -- this is called adherence. Many people find they can deal with the side effects and adhere to their recommended pill-taking schedule, especially if they've had time to prepare.

Sometimes, treatment doesn't work: it may not be able to control the HIV in a person's body, or the side effects or number of pills may be too much to bear. Most people are able to find an alternate combination if the first one does not work out. However, second, third or later combinations need to be chosen carefully. We talk more about changing treatment later in the guide (see "Changing Treatment").

This guide is intended to guide you through what we know (and don't know) about HIV treatment. We hope it gives you enough information to make you feel more confident about discussing your treatment decisions with your doctor.

Resources

Managing Your Health -- a guide for people living with HIV

The Positive Side -- health and wellness magazine for people living with HIV (www.positiveside.ca)

ASO411 -- a listing of AIDS service organizations and other HIV-related services throughout Canada (www.aso411.ca)

These and many other relevant resources can be accessed on CATIE's website (www.catie.ca), through the CATIE Ordering Centre or by calling CATIE at 1-800-263-1638.