Starting HIV Treatment

• First Things First
• Choosing an HIV Drug Regimen
• Resistance
• Sequencing
• Adherence
• Dosing Schedule
• Taking Your Pills
• Side Effects
• Putting It All Together

First Things First

When you and your health care provider decide the time is right for you to start treatment, there are things you can do to set yourself up for success. The first step is to think positively. Having the right attitude going in will help you get the most out of your treatment. Remind yourself that:

• Starting treatment is the right decision for your health
• The HIV drugs will help you fight the virus
• You can take your medications the right way
  

It takes a lot of commitment to stick to a treatment regimen (combination of HIV drugs). There is no need for you to go it alone. Your health care provider is an important support and so are other people such as nurses, social workers, therapists, and case managers. You may want to join a support group for people living with HIV (HIV+ people) or check out our online support community, A Girl Like Me. Family and friends can help, too.

It can be tough to stick with a treatment regimen if you need to work on other issues in your life. If you feel down a lot of the time and do not enjoy things that you used to enjoy, you may be depressed. If you are depressed or feeling low, it is important to talk with your provider and get the support you need. The same goes for any issues you have with substance use or abuse. Taking care of problems with depression or substance abuse can really help you take your HIV drugs regularly and be as healthy as possible.

Tell your health care provider if you have other health problems, are taking any other drugs (including over the counter medications, vitamins or supplements, or street drugs), are using any alternative or complementary therapies, or are in any recovery programs. This is important information that may affect your treatment options. In addition, discuss family planning with your health care provider since HIV drugs can interfere with some birth control methods and pregnant women should not take certain HIV drugs.

Choosing an HIV Drug Regimen

The next step is for you and your health care provider to choose a drug regimen. Currently, there are 30 drugs approved for HIV treatment. They are grouped into five classes:

• Entry inhibitors (includes fusion inhibitors and CCR5 antagonists)
• Integrase inhibitors
• Nucleoside/nucleotide reverse transcriptase inhibitors ("nukes" or NRTIs)
• Non-nucleoside reverse transcriptase inhibitors ("non-nukes" or NNRTIs)
• Protease inhibitors (PIs)

There are many ways to combine the drugs, but experts recommend that people who have never taken HIV drugs before start with one of the following combinations:

• An NNRTI plus 2 NRTIs or
• An integrase inhibitor plus 2 NRTIs or
• A PI plus 2 NRTIs [in most cases the PI should be combined, or "boosted," with a small dose of a second PI called Norvir (ritonavir); this makes the first PI work better]
  

More information about which drugs to take can be found in the US government's treatment guidelines.

Resistance

With any HIV regimen, a major problem can be the development of resistance. When HIV makes copies of itself (reproduces), it can make changes, called mutations. Some mutations prevent certain HIV drugs from working. When this happens, we say that HIV has become "resistant" to a particular HIV drug. Your viral load can increase quickly if resistance occurs and you may have to switch regimens.

In addition, if you become resistant to one drug, you become resistant to other drugs in the same class. This is known as cross-resistance. The more drugs you are resistant to, the fewer treatment choices you have.

Resistance Tests

Before starting HIV treatment, it is important that your health care provider do a resistance test to find out if you have drug-resistant HIV. This helps determine which drugs will work best for you. The treatment guidelines recommend resistance tests for:

• People who have just become infected with HIV, whether or not they are going to take HIV drugs right away
• People who have never taken HIV drugs and are starting to receive medical care, whether or not they are going to take HIV drugs right away
• People who have never been on HIV drugs and are planning to start
• People who are on HIV drugs and see their viral load go up
• People who have recently started HIV drugs and their viral load is not coming down enough
• Pregnant women living with HIV

Sequencing

One of the strategies in HIV treatment is to think ahead. We know that drugs may stop working because of resistance and cross-resistance. When you and your health care provider choose your first regimen, it is also important to think about which drugs could be used in future regimens if your original HIV drugs stop working. This process is called sequencing. It ensures that you will have other treatment options available if resistance develops.