STEP 4: Learning About HIV Treatment

HIV & Me: An African American's Guide to Living With HIV

Now that you have figured out where you can get good care, one of the first questions you're likely to have is:

"We know that some black people bring mistrust of the medical system into their clinic visits ...

"It's my job, as a provider, to give people information and to earn their trust, but it really helps people when they enhance their own learning and bring that into the clinic visits too."

-- Dr. Adaora Adimora, physician at University of North Carolina-Chapel Hill

To read more about Dr. Adimora, click here.

WHEN IS IT TIME TO START TAKING HIV MEDICATIONS?

Your HIV-positive test result won't tell you the answer. All it tells you is that you've been infected with HIV. Some people can live many years with HIV before they need to take medications to control it.

However, every person who tests HIV positive should immediately have two additional tests: a CD4 count and a viral load test. These tests are the critical measuring tools you and your doctor will use to see what the virus is doing in (and to) your body.

THE CD4 COUNT TEST. This test, also known as a "T-cell count test," gives an indication of the number of CD4 cells in your bloodstream. The more CD4 cells you have, the stronger your immune system is. After living with HIV for a while (if you don't take medications), the number of CD4 cells you have will usually fall. This is a sign that your immune system is being weakened. A normal CD4 count for someone without HIV is usually between 500 and 1,600. Experts generally agree that when your CD4 count goes below 350, you're at a high risk for developing potentially dangerous illnesses, so you should begin taking HIV medications before your CD4 count hits 350.

THE VIRAL LOAD TEST. Viral load tests provide an estimate of how much HIV is circulating in your blood. Generally speaking, your viral load is not considered as critical as your CD4 count in determining the health of your immune system. However, once you begin HIV treatment, it is a good measure of how well your HIV medications are working.

A viral load test measures the amount of HIV in a small amount (milliliter or mL) of your blood. Current viral load tests can detect as few as 50 copies of HIV per milliliter of blood. When your viral load test indicates that you have fewer than 50 copies/mL of HIV, your health care provider will tell you that your viral load is "below the limit of detection," or "undetectable." This does not mean that you no longer have HIV in your body. Even someone who has an "undetectable" viral load can transmit HIV to someone else. However, an "undetectable" viral load means that your medications are doing an excellent job of keeping HIV in check.

DO HIV MEDS WORK DIFFERENTLY IN AFRICAN AMERICANS?

Generally, whether a person is black or white, HIV meds appear to work the same way. The real problem, experts say, may be that African Americans are already at a higher risk for some health problems that HIV meds can cause or worsen.

THESE HEALTH PROBLEMS INCLUDE:

High blood pressure (also called hypertension)
High cholesterol
Anemia (a low blood count, which can make you feel tired)
Diabetes
Hepatitis C (which, over time, can cause liver damage)
Kidney disease

DEALING WITH HIV AND OTHER ILLNESSES?

Be sure to stay on top of HIV as well as any other infections or illnesses. If you are infected, for example, with HIV and hepatitis B or C, your physician may refer you to a liver specialist who also specializes in HIV.

If you are seeing other health care providers, besides your HIV specialist, be sure that they are all in contact.

Current Guidelines Recommend:

It is recommended that HIV medications be started no matter what your CD4 count is if you have serious symptoms, if you are pregnant, if you have HIV-associated nephropathy (a kidney disorder) or if you need treatment for hepatitis B.

The urgency of starting HIV treatment depends on your medical history and CD4 count.

• If your CD4 count is above 500, you can hold off on HIV medications, but many experts feel that it's good to start, just to be safe.

• If your CD4 count is betweeen 350 and 500, you should begin treatment to protect your immune system from future damage.

• If your CD4 count is below 350 or you've had an AIDS-defining illness, you should start treatment immediately to avoid serious illnesses.

At least once every three to six months, you should visit your HIV care provider for a checkup. This will help you both stay on top of your health and make treatment adjustments as needed.

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