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Your Ability to Start and Maintain
Part Two of Three in Project Inform's "What You Should Know About When to Start and What Meds to Use" Booklet

July 2011


Keeping Up With Taking Meds

All HIV meds go through extensive research to find the optimal dose to keep HIV under control, without causing unnecessary side effects for most people. They're usually taken once or twice a day, with or without food, because that's the best amount of that drug to suppress HIV. For this and other reasons it's important to adhere to your drugs, which means to take every dose as prescribed every day.

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One main reason to adhere to your regimen is to prevent resistance: a key reason why treatment fails to keep HIV under control. It will eventually force a person to change to another regimen.

Sometimes people don't take their HIV meds when they feel sick from a cold or the flu. Others won't take them because of, or even for fear of, side effects. Sometimes, life just gets too busy to remember to take every dose. If you miss a dose, don't panic: take the next one on time and try to get back on schedule.

In the case of side effects, it's better to try to manage them for awhile rather than miss a dose, take fewer pills or quickly change your regimen. Some HIV meds may cause fewer side effects if you take them at bedtime or with a meal. Other medicines can be used to lessen side effects like nausea. Consult your doctor for help with side effects, especially difficult ones.

Be sure you understand how to take the medicine. Don't be embarrassed to ask your doctor, physician's assistant or pharma­cist what the prescription mean. For example, once a day doesn't mean whenever you want to take it each day. It means to take it every 24 hours. Don't be afraid to ask others for resources or suggestions to support your adherence.


Side Effects

Your Ability to Start and Maintain

Although most people wonder or worry about side effects, it's impossible to predict who may have them. All drugs, including HIV meds, can cause side effects but not everyone will have them. Some people experience few or no side effects, while others have ones that are manageable. For still others, side effects may be moderate to severe, and can interfere with quality of life. You may also hear a troublesome story from someone else, but that doesn't mean you'll experience those same side effects from the same drug or regimen. HIV drugs affect everyone individually.

Short-term side effects (like headache, fever, nausea) normally appear during the first few weeks of taking a new drug. They often get better or disappear as your body gets used to the meds. Occasionally, side effects reappear due to stress or other infections.

In general, people with better overall health usually experience fewer short-term side effects. If you start later when you're less healthy, you may experience more symptoms.

You and your doctor will keep track of long-term side effects by routinely running blood tests. These can include changes in blood fats or in certain blood proteins (such as ALT, AST, amylase and creatinine) that indicate possible problems with certain organs, including the liver and kidneys. Over time, these changes can progress to other conditions like diabetes or liver disease.


Drug Interactions

Drug interactions are possible whenever you take two or more drugs together, whether they're prescriptions, over-the-counter drugs like cold medicine, recreational drugs or even herbal products. Even food can interact with drugs. The more meds you take, such as hormonal birth control or meds for high blood pressure or even erectile dysfunction, the more likely you could experience an interaction. This is also true about taking HIV meds with some herbal products, especially St. John's Wort.

Given the number of drugs used to treat HIV and other conditions that are common among HIV-positive people, possible drug interactions are more likely. Not only does each drug have its own possible side effects, that drug may also increase or decrease the effectiveness of other drugs. Drug interactions are not always considered when making treatment decisions, but they can certainly play a major role in its success.

Thinking ahead about possible interactions can help you avoid unnecessary side effects. Make sure your doctor knows about all the drugs and supplements you take, including over-the-counter products and recreational drugs. Don't forget that your pharmacist can be an invaluable resource. Drug interaction tools are also available online.


Women and HIV Treatment

Pregnancy

Understanding the Details of HIV Treament

One of the greatest successes of HIV treatment is our ability to prevent passing HIV from mother to baby during pregnancy or birth, provided the woman has ongoing access to care and treatment. Several things should be considered when taking HIV meds during pregnancy: ensuring the health of the woman, protecting the baby, when to start, drug choice and drug side effects.

It's important that the doctor you choose is experienced with HIV, women and pregnancy. The US Guidelines recommend that all HIV-positive pregnant women be on treatment, regardless of CD4 count or viral load. Some doctors recommend that women with early-stage HIV disease not start treatment during their first trimester, when the baby's organs are developing. You should weigh these benefits and risks with your doctor.

Some conditions, like diabetes, are common in pregnant women. Some HIV meds may worsen these conditions to some degree. A few HIV meds should not be taken during pregnancy, including Sustiva (due to its risk of birth defects), and Viramune (which may cause severe liver disease in women with CD4s above 250).

If protease inhibitors are used, their dose may need to be increased during the third trimester. It's recommended that Retrovir be included due to its ability to prevent trans­mission, unless the woman develops severe side effects, or is resistant to it, or is also using Zerit. Videx + Zerit should not be used.

Breast-Feeding

Understanding the Details of HIV Treament

HIV is present in breast milk and may be passed from mother to child during breast-feeding. Therefore, the US Guidelines recommend that mothers use formula to feed newborns. This works best when there is easy and ongoing access to formula as well as clean water and refrigeration. HIV meds may be passed through breast milk, although this has not been well studied for all drugs. Women should consult experienced maternity doctors to fully explore their options. Acredited national or local breast milk banks may also be an option and may meet the infant's need for breast milk.

Contraceptives

Many HIV meds, mostly protease inhibitors and NNRTIs, can interact with hormonal birth control pills (those that contain (ethinyl estradiol, norethindrone). These interactions can alter the potency of the birth control pill or HIV meds. In this case, women may consider other HIV meds or use another form of birth control instead of, or in addition to, the pill. Less is known about how HIV meds interact with the transdermal patch or vaginal ring interacts with HIV meds.


Power of the Mind

Your Ability to Start and Maintain

The power of the mind in health and healing can really make a difference over time. Nearly two out of three people in clinical studies who take a placebo (a sugar pill with no medicinal value) get some of the same benefits as people taking a real drug. This is because they believe that what they're taking is good for them. This can also apply to HIV-related medications and alternative therapies.

If you believe that a particular medicine is "poison," chances are you'll experience side effects and won't do as well on it. On the other hand, if you believe that something you're taking is good for you, then you'll more likely have an overall better experience with the treatment and perhaps experience fewer side effects.

In exploring your beliefs about a medicine, you might find you've come to a conclusion based on fears or rumors. Grounding yourself in facts, rather than fears, is critical to making good decisions. Personal experience and knowledge about a given medicine is far better information to inform your decisions than fears or conjecture.


Previous: Understanding the Details of HIV Treament | Next: Getting Ready to Start HIV Treatment
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