Issues to Consider Before Starting Treatment

Once you've found a good doctor, but before starting treatment, there are many issues -- both medical and non-medical -- that you may want to consider. By taking the time to think about these before you swallow the first dose of your HAART medications, you may greatly increase your chances that the drugs will continue to work well for you over time and that you will be able to live well while taking them.

• Check your CD4+ count and your viral load. Don't ever make a decision based on the results of a single test; instead, always watch for trends. Review your previous test results with your doctor. Have your test results stayed about the same? Have your CD4+ cells significantly dropped over the past year? Has your viral load significantly gone up?

• Assess your general health. Have you had symptoms of long-term infection, such as chronic fatigue, weight loss, skin problems or diarrhea? Have you had infections that keep coming back even though you've taken treatment? Have you had an AIDS-related illness, such as PCP?
  Advertisement

• Do you have other health conditions that could complicate your HIV treatment? For example, hepatitis causes liver damage that could be made worse by some drugs. Depression, anxiety, or alcohol or recreational drug use can sometimes affect your ability to stick to a strict medication schedule.

• How do you feel about taking medication on an absolutely precise and regular schedule? Are you able to make that commitment? The drugs only work when you take them. To keep your drug cocktail working, you must be able to very consistently stick to the schedule. Skipping doses can lead to drug resistance that will cause treatment failure (see "Drug Resistance" section), so you must be ready to make a firm commitment to taking the drugs precisely as directed in order to avoid this.

• What are your own feelings about anti-HIV drugs? Some people have strong feelings of skepticism or fear about taking them. It is very important to discuss such feelings with your doctor and work through them before beginning to take medications. If you're looking at each pill thinking "Ewww, it's a poison," the result is not likely to enhance your ability to stick to a regimen and may create immune-damaging stress.

• Have you taken the time to understand all aspects of the treatment regimens you are considering and to think carefully about how each will affect you? Taking medication daily will have an effect -- and sometimes a very dramatic one -- on your life and your lifestyle. While most drugs can be taken with food, a couple of them must be taken on an empty stomach. Some drugs are taken only once a day, while others must be taken two or three times a day. Is your life fairly structured, and do you enjoy keeping to a routine every day? If so, then a cocktail that requires three doses per day might work well for you. If your lifestyle is more unpredictable or your schedule often erratic, then a drug cocktail that you take once or twice a day with meals may suit you better.

• Don't forget about work or social situations. Is your HIV status unknown to your coworkers or friends or those who share your living space? Is that a huge concern to you? If so, you will have to decide if you are willing to begin a demanding drug regimen despite concerns in this area. Once you have decided to do so, you should also consider whether some regimens may be preferable to others in this regard. For example, you may prefer a regimen that allows for less frequent dosing or fewer pills as a way to help ensure that your pill-popping remains a private affair. You may also need to strongly consider likely side effects. Let's be blunt: If diarrhea or stinky gas is a common effect of one or more of the drugs you're considering, you'll have to look at your work and home situations to see if such things are likely to be noticed. Although there is much that can be done to address many of the drug side effects (see CATIE's Practical Guide to HIV Drug Side Effects), there are no guarantees that you will be able to eliminate all of them, and the likelihood is that one or more of the effects might cause you problems that are noticeable to others.

• There are other important reasons to consider possible drug side effects of both the short- and long-term variety. Not everyone will have much in the way of side effects, and for some they may be mild or barely noticeable. However, for many others, side effects may be much more severe and may interfere with daily life. You should consider practical realities. If reaching your workplace requires a long commute with no possibility of bathroom stops, medications that cause diarrhea might be particularly difficult for you. If your job requires long hours on your feet, neuropathy might be harder for you than for someone who can sit down on the job. In general, it is crucial to learn as much as you can about side effects and how to cope with them before starting treatment. As discussed in CATIE's Practical Guide to HIV Drug Side Effects, there may be nutritional and other remedies that may help prevent side effects or at least greatly lessen their severity.

By considering these issues prior to starting treatment, you will give yourself the best chance of living well with HIV, not just longer.