Introduction

The decisions that people living with HIV and AIDS (often referred to as PHAs or PWAs) must make about treating the disease can often seem overwhelmingly difficult. In this guide, we hope to provide the latest on what is currently known about the various aspects of treatment, as well as a bit of skepticism about anyone claiming to have definitive answers on this topic. We don't know it all, but we will try to tell you what is known and, sometimes more importantly, what is not known about infection with the Human Immunodeficiency Virus (HIV) and how to treat it.

If you have only recently been diagnosed as HIV positive -- or just want a refresher course on the basics -- you may want to start at the top to read our description of the virus, the immune system that fights it, the stages of the disease, the drugs that attack it at each point in its life cycle, and the tests that will be used to assess your health status. Having a basic understanding of all of the above is very useful for anyone living with HIV or AIDS. It will help you understand the HIV information you read, increase the likelihood of effective communication with your doctor(s), and, we hope, assist you in your journey along the path of making treatment decisions.

If you've been around the HIV world for quite some time but are now considering starting or changing drug therapy, you might want to skip down to the section on, you guessed it, "Treating HIV." Because HIV belongs to a group of viruses called retroviruses, treatment to fight HIV infection is known as antiretroviral therapy (ART) or anti-HIV treatment. Because we have learned that the best way to treat HIV effectively is with a combination of at least three antiretroviral drugs, you will most often see this multiple-medication approach referred to as HAART, which stands for Highly Active AntiRetroviral Therapy, or as a drug cocktail or combination therapy. If someone asks you about your HAART medications, they aren't presuming that you have blocked arteries. And when they want to know what's in your cocktail, they aren't trying to find out your secret recipe for the perfect martini.

Throughout this guide, we've tried to explain all the basic terms you'll need to know. However, if you're new to the world of HIV, it might be a good idea to also take a glance at an AIDS glossary and learn some of these basic terms. Otherwise, you might sometimes feel that everyone's speaking in a secret code.

Here are some HIV/AIDS glossaries that are available on the Web:

• Gay Men's Health Crisis (GMHC) -- AIDS Medical Glossary: www.gmhc.org/health/glossary.html

• HIV/AIDS Treatment Information Service (ATIS) -- 4th edition of the Glossary of HIV/AIDS-Related Terms:
  http://aidsinfo.nih.gov/

• San Francisco AIDS Foundation -- Glossary of HIV/AIDS-Related Terms: www.sfaf.org/custom/glossary.aspx

At the time of this writing, there are more than 20 antiretroviral drugs (including the various combinations and formulations) available in Canada. Many other drugs are being studied, and several should become available within the next couple of years. Some of the latter are already options for those willing to enter the clinical trials where they're being studied. This obviously means that there are now a huge number of possible therapeutic combinations.

For many thousands of PHAs, these combinations have extended life and improved health. In many cases, when effective drugs are available, their use can result in significantly restored immune function and the ability to fight off the infections that once would have been fatal. So instead of what many would have once considered an inevitable downhill slide into illness and death, there is now hope that -- for those living in parts of the world where the drugs are available -- disease progression can be slowed down or even reversed.

But there are downsides that have become more evident the longer people have stayed on HAART:

• First, in some people, there are very serious side effects and long-term complications that can result from these powerful drugs. Even a single drug can cause side effects, and using several at the same time means that this risk increases. For many people today, the miserable symptoms that are sometimes caused by drugs are the major issue in their ability to continue taking them.

• In addition, many people have trouble sticking to the scheduling and other requirements of their drug regimens over the long haul. Continuing to take the drugs exactly as directed is called adherence. Not doing this, non-adherence, is a major cause of drug resistance and, ultimately, drug failure (for a full discussion of what this means, see the "Drug Resistance" section).

• And that leads us to the many people who have been on treatment for a long time for whom the drugs have quit working in the way that is needed. For those people -- called the treatment-experienced or the heavily pre-treated -- there may be few or no remaining treatment options.

So, while scientific advances have increased our understanding of HIV disease and provided new weapons in the fight against it, HIV treatment has grown more and more complex. And there are many questions to which we do not yet have definitive answers. Even the opinions of experts in the field often vary on such questions as the best time to start treatment, the best combination of drugs to use and in what order to use them, whether treatment should be continued lifelong or cycled in various ways, and so on. This guide is intended to provide a summary of the current scientific thought on these and other issues. There are no simple answers here, but there is information that may help you make decisions about treating HIV in the most effective and lifestyle-friendly way possible.