Changing Treatment

Even with careful planning and sticking to the schedule perfectly, you may have to change your drug cocktail. Sometimes the combination doesn't work to control HIV. At other times, it just doesn't work for you.

As discussed previously, monitoring viral load is the best way to know whether your current drug combination is successful in maintaining viral suppression (for a full discussion on interpreting viral load results, see "Viral Load" section). Any time you plan on starting therapy or making a change, it will be important to make advance appointments with your doctor so that viral load tests can be done at the appropriate intervals. You don't want to be two days away from the time your next blood draw should be performed when you discover that your doctor has no openings for several weeks. Carefully discuss this issue with your doctor before any changes are made and get those appointments on the books.

If viral load results point to treatment failure, it will be time to talk to your doctor about changing your drug combination. It's a good idea to explore with your doctor why your treatment did not work. If you still have plenty of treatment options, a whole new combination of drugs you've never used before is probably best. That's what is most likely to give you powerfully effective viral suppression. If you are among the many with much more limited options because of extensive previous drug use, consider doing resistance testing to check the possibility that only one of your drugs is actually failing. If this is the case, it might be possible to just find a substitute for the medicine that is no longer working. Another possibility for those experiencing drug failure with their standard three-drug regimen is the "kitchen sink" approach, discussed previously.

If the problem with your drug regimen is not viral control failure but rather side effects, it is terribly important to discuss with your doctor ideas about obtaining therapy that might help counter them. Consider the possible remedies for the most common side effects that are discussed in CATIE's Practical Guide to HIV Drug Side Effects, and then talk with your doctor and perhaps see a naturopathic doctor or nutritionist. By implementing an integrated approach to HIV -- combining the best available drugs with the remedies that help eliminate side effects and other symptoms -- you give yourself the best long-term chance for happily staying on your drugs, instead of miserably. This will mean that you can gain all the benefits that drug therapy can offer, while eliminating the problems that might have sabotaged your ability to adhere to the drugs and compromised your quality of life. If all the possible remedies fail to eliminate side effects that you find unbearable, then it will be time to discuss with your doctor changing your cocktail to one that you may find more tolerable.