Walking Your Way Through Making a Decision

When considering therapy, there are many issues to keep in mind. Though research has not defined an absolute standard time to start anti-HIV therapy, some criteria can assist you in making a decision tailored to your needs. This road map highlights these criteria and may help you in this process. It may be a good idea to bring this with you to your doctor's appointment for discussion. Remember, take your time and don't feel pressure to make the decision today.

Your Readiness and Belief in Therapy

1

Before you start any kind of medical treatment make sure that you're ready. Take time to reflect and contemplate how taking therapy is going to impact your life. Ask yourself questions like: Do I feel ready? What kind of expectations do I have? Do I have a support system or someone I can talk to about therapy? Am I scared? If so, of what am I afraid? Explore your own beliefs and fears about therapy. Ground yourself in knowledge rather than fears. Talking to other people about their treatment decisions can be extremely beneficial, but remember . . . what works for one person does not always work for another.

CD4+ Cell Counts

3

What is your current CD4+ cell count?

Over your last few tests, has your CD4+ cell count trend:

• gone up; or
• gone down?

Is your CD4+ count generally declining or is it mostly stable, with just modest movement (100 points or less) up and down? A stable CD4+ count, as long as it is above 200, has less risk of progression than one that is steadily declining.

CD4+ Cell Count Above 500 (Normal Range 500-1,500+)

Maintain good healthy habits (nutrition, exercise, monitor disease progression and labs).

Therapy is generally not recommended. If your viral load is high and/or you're experiencing symptoms, therapy might still be warranted. However, if the CD4+ count is declining rapidly and consistently, and the viral load is high, some doctors might recommend treatment or more frequent monitoring.

CD4+ Cell Count 200-500

If you are in this range, you may want to consider therapy, especially if you have developed symptoms associated with immune dysfunction. Examples include shingles (zoster), and recurrent and aggressive yeast infections. When no symptoms are present, most doctors would consider delaying treatment at least until the CD4+ count consistently falls below 350.

Guidelines suggest considering therapy when CD4+ cell count is consistently at or below 350.

If your CD4+ cell counts are above 200, and you experience recurrent fungal infections (thrush, etc.), preventive therapy for Pneumocystis carinii pneumonia (PCP) is recommended.

CD4+ Cell Count 200 and Below

There is an increased risk for developing serious and life-threatening infections (opportunistic infections) and therefore the federal guidelines highly recommend anti-HIV therapy.

If you choose not to use antivirals at this point, talk with your provider about preventive therapies against common infections, like Mycobacterium avium complex (MAC), cytomegalovirus (CMV) and toxoplasmosis. Monitor your lab values, weight, minor symptoms and overall sense of well-being.

If your CD4+ cell count and/or viral load levels change drastically from one test to another, discuss this with your provider. Large sudden changes are often the result of lab errors or other health factors (like a flu shot or stress).

For more information, read Project Inform's "Blood Work: A Useful Tool for Monitoring HIV."

What About Side Effects?

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There are many side effects from anti-HIV therapy. It's important that you are aware of them and learn how they can be monitored and managed. Not everyone on therapy experiences side effects (only 10-20% of people have serious ones). It's not uncommon for people to have some short-term side effects like nausea and headaches during the first 4-6 weeks of therapy. After this adjustment period, short-term side effects often diminish. Therapies can have long-term side effects too, including body changes (called lipodystrophy) and changes in lab results like cholesterol.

For more information, read Project Inform's "Drug Side Effects;" "Lipodystrophy Syndrome(s);" and "Mitochondrial Toxicity and Lactic Acidosis."

Adherence

6

Adherence is crucial to treatment being effective. Adherence means taking medications exactly as prescribed by your provider. If anti-HIV medications are not taken according to instructions, the risk of developing drug-resistant HIV increases. Drug-resistant HIV may not respond to the anti-HIV drugs and, as a result, treatment options become limited. Numerous factors can influence adherence: the responsibility of children, your housing status, busy and demanding work, potential side effects from anti-HIV drugs, being in a domestic violence situation and many others.

Take a moment to reflect upon the various factors that can make taking your medications correctly challenging. Discuss this with your provider as you develop a treatment strategy. In addition, use those sources of support which will motivate you to stay adherent.

For more information, read Project Inform's "Adherence: Keeping Up with Your Meds" and "Drug Dosing Schedule."

Drug Interactions

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Are you currently on any other therapy (contraceptives, methadone, anti-depressants, etc.)?

There are known drug interactions between a variety of drugs, and even herb-drug interactions. These can worsen side effects and/or cause one or both therapies to be less effective. For example, some protease inhibitors can decrease the level of ethinyl-estradiol (chemical in oral contraceptives), making them less effective.

If you decide to take therapy, take all the medications, vitamins, supplements and/or alternative therapies that you're taking to your next doctor's appointment. Whenever you add or change a therapy or supplement, be sure to talk with all your health practitioners (and pharmacist) to make sure these products may be taken together safely.

For more information, read Project Inform's "Drug Interactions."

Back to the Project Inform WISE Words December 2001 contents page.