Getting the Most Out of Treatment
The goal of this issue is to help you take a more active role in your care, to have more control over your treatment decisions, and to get the most out of treatment. Many factors contribute to successful treatment. To varying degrees, some are beyond your control -- genetics, lack of access to quality care, coexisting medical conditions, insufficient personal and community support, and needs like housing that take precedence over health concerns.
Other factors are more within your control -- adherence (consistently taking the correct dose at the right time and following any food restrictions), scheduling and showing up for medical appointments, and getting answers to questions you have about your health and treatment.
This issue of Positively Aware focuses on some things that can happen inside your body that affect treatment.
Tim Horn's discussion of pharmacokinetics (PK) -- a somewhat intimidating word that means how your body processes a drug from the time you take it until it's eliminated -- describes how PK research has led to better treatment options for people with HIV and continues to do so.
Anne Monroe explains gastrointestinal conditions and the ways they can negatively affect treatment, while Joel Zive focuses on drug interactions and how interactions between HIV medications and other substances, including other drugs, herbs, and food, can impact treatment.
Jeannine Bookhardt-Murray's article about navigating the healthcare system includes practical tips for dealing effectively with members of your healthcare team. For many readers, hers may be the most directly useful piece in this issue.
We've also included a Personal Health Record that you can pull out and use to track your test results, vaccinations, and other important health information.
As HIV treatment becomes increasingly complex, writing about treatment issues becomes more challenging. All of science is complex, of course, and medicine is no exception. The potential for miscommunication is ever-present when we try to provide accessible treatment information. Reducing complicated issues into misleading, oversimplified, or incomplete information is always a danger. We faced many of the usual challenges as we put together this issue of Positively Aware.
One challenge was whether to include discussions of four HIV medications that are very rarely prescribed -- Hivid, Rescriptor, Agenerase, and Fortovase. Since these drugs are approved by the Food and Drug Administration, on the market, and used by some people with HIV, we chose to include them. We felt it was important to discuss these medications since a few people who are on one of them might read this issue. If we were to omit them, a reader could well wonder why they're taking a medication that, according to Positively Aware, isn't used to treat HIV.
Another example of a challenge when presenting treatment information is in the discussion of potential interactions between proton-pump inhibitors (PPIs) and HIV medications. PPIs are used by many people with HIV to treat gastroesophageal reflux disease (GERD) and ulcers. Some PPIs are known to interact with certain HIV medications. But none of the PPIs have been studied with every HIV medication, so it would be inaccurate to write that each PPI interacts the same way with all of the HIV medications in a given class just because we know that one does. On the other hand, to describe the details of each individual interaction study would take up a huge amount of space and be of little or no value to most readers. We hope that we've presented the information about PPI interactions and similar information in a way that's accessible yet still accurate.
Finally, when providing information about various drugs or regimens, we try to be objective. Unless we're writing an opinion piece or describing data that clearly demonstrates the superiority of one drug over another, we do our best to discuss each HIV medication objectively. Since we're human and have personal biases, this isn't always easy. But we try to avoid bashing one drug or making another look better. This would actually be easy to do by selectively choosing which data to write about. Editors, colleagues, and medical reviewers are essential to the process. As much as possible, they help to ensure that bias doesn't creep into the final product.
These are just a few of the challenges we face when writing about treatment. Sometimes we get things right -- sometimes we don't. That's one of the many reasons that hearing from readers is so important.
It has been a privilege to work on this special issue of Positively Aware. It's allowed me the opportunity to collaborate with thoughtful, dedicated writers and the terrific people at TPAN. I've contributed to Positively Aware often over the years and am always inspired by the editorial staff's professionalism and commitment to make sure that the content is relevant to the publication's diverse readership. I thank TPAN for inviting me to edit this issue. Above all, I hope that it provides information and tools to help you get the most benefit from your HIV treatment.
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