February 2012
Table of Contents
Treatment with HIV drugs can improve quality of life and help people living with HIV (HIV-positive people) stay healthier longer. But starting treatment is a big decision. In order to get the most benefit from HIV drugs, they must be used just the way they are prescribed. Taking your treatment correctly is as important as which drugs you and your health care provider choose. So before you get started, make sure you are ready to commit to taking your HIV drugs the right way, every day for your own health! This takes a combination of the right health care provider, enough knowledge about HIV, and a positive attitude.
You and your health care provider are a team working together to make the best treatment decisions for you. Ask yourself a few questions: Do I have confidence in my provider? Can I be totally honest with him or her? Is he or she available when I have questions? Does he or she take my concerns seriously? If so, great!
If not, try to make changes. Write down the questions you would like to ask your health care provider before you go to visits. It is important to answer your provider's questions with the truth, not with what you think she or he wants to hear. If that still does not work, it may be time to look for another provider.
It is also wise to have a health care provider who is an HIV specialist. Health care providers who devote most of their time to HIV are best able to manage this complicated condition. Helpful suggestions for HIV specialists near you can come from friends, ASOs (AIDS Service Organizations), or by checking with the American Academy of HIV Medicine (AAHIVM). To find an ASO in your area, click here or look at the AAHIVM's Referral Link.
HIV is a virus that infects and destroys CD4 cells. CD4 cells are part of the body's immune system. The immune system protects the body from germs. When the immune system loses too many CD4 cells, it becomes weak and is unable to fight off germs. At this point, HIV+ people are at risk of getting opportunistic infections (OIs) that can cause serious illness or death.
Scientists have developed drugs that stop HIV from making copies of itself (multiplying). These drugs are grouped into classes. Each class of drugs works to stop HIV at a certain point in its life cycle. So far there are five classes of drugs:
HIV drugs are always used in combination to attack the virus at different points in its life cycle. This usually means using drugs from at least two different classes. Combining HIV drugs is the best way to reduce the amount of HIV in your blood (viral load).
Before you start HIV treatment, your health care provider should have you take a number of blood tests. These are your original, or baseline tests. Future test results will be compared to your baseline results to see how you are doing and how well your treatment is working.
The US government has put together a list of guidelines to help people decide when to start treatment:
Some experts feel that it is a good idea to start treatment earlier -- with a CD4 count above 500 and no symptoms. There are risks and benefits to doing this.
Benefits of Starting Early:
Risks of Starting Early:
When considering when to start treatment, you and your provider will also look at your overall health, and your readiness to start and stick to lifelong treatment. Talk to your health care provider to make sure you understand the importance of adherence (see below) and to make a plan to address any barriers to adherence before starting.
Whenever you start treatment, you need to take your drugs on schedule and exactly as prescribed. This is called adherence. In order to get the maximum benefit from HIV therapy, good adherence is required. This is because HIV drugs need to be kept at a certain level in your body to fight the virus. If the drug level falls, HIV may have a chance to fight back. Skipping doses, not taking the drugs on time, and not following food requirements can all cause your drugs to be less effective or to stop working altogether.
After starting HIV drugs, you should see your viral load decrease and your CD4 cells increase. Over time, however, some people see their viral load increase, even though they are still taking HIV drugs.
When a drug is no longer able to fight HIV effectively, we say that HIV has become "resistant" to that drug. If you develop resistance, you will likely have to change some of the drugs in your regimen. If your viral load goes up while you are still taking your HIV drug regimen, your health care provider should offer you a resistance test to find out which drugs are not working and to help choose ones that will. For some people with resistance to many HIV drugs, it may be difficult to find a new combination.
The best way to fight resistance is to be adherent to your drug regimen.
If you decide the time is right to start treatment, try to have a good attitude going in. It is important to believe that:
It may also help to get in touch with the reason you are starting treatment -- to keep yourself in good health, whether for your own sake or for the good of your family.
Whatever decision you make, do not go it alone. Put together a support system that may include your health care provider, social workers, case managers, family, or friends. You may also consider joining a support group of other HIV+ people.
The more you think and talk about your decision, the better the outcome. Whatever you decide to do, keep going to your health care provider for regular check ups and blood work.