Antiretroviral (ARV) therapy slows HIV and lets positive people live longer, healthier lives.
Antiretroviral (ARV) therapy slows HIV and lets positive people live longer, healthier lives. But when should you start treatment? Truth is, there’s really no right or wrong answer—it depends on the individual. Working with your health care provider, you’ll make the decision based on a number of factors, including your CD4 cell count (see “Know Your Lab Tests” on the next page), other health issues you’re facing and your mental readiness to start treatment and stick with it.
“Every time researchers look at the question of when to begin treatment,” says Richard Loftus, MD, president of the Health Management Institute in San Francisco, “the answer keeps coming back that the higher your CD4 cells over the course of your life, the better they will protect you against health problems—not just AIDS-related infections, but also many types of cancer.”
If you and your care provider decide it’s time to start, your next task is to pick a combo. Today, there are more choices than ever, in five drug classes (each disrupts HIV at a different point in its life cycle). There are nucleoside/nucleotide reverse transcriptase inhibitors (known as NRTIs or nukes), non-nucleoside reverse transcriptase inhibitors (NNRTIs or non-nukes), protease inhibitors (PIs), entry inhibitors (EIs) and the latest addition to the list of possibilities: an integrase inhibitor. Learn more at AIDSmeds.com.
HIV meds are taken in combination because when one drug is used alone, HIV may quickly develop a way to outsmart it (a.k.a. resistance). It’s easier to control HIV when you hit it at a few different points in its life cycle. Standard treatment combines at least three meds, and today’s choices allow for therapy tailored to your unique needs. Some things to consider when choosing meds:
Drug Resistance: Has your virus been checked to make sure that all of the available medications will work against it?
Other Health Considerations: Which meds should you avoid if you plan to become pregnant, or if you are depressed or have other medical problems, such as cardiovascular, liver or kidney disease?
Safety and Toxicity: What are the side effects, and which ones are you more prepared to deal with?
Convenience: Once- or twice-daily dosing?
Works With Others: Do they interact with other meds you take?
Loftus warns his patients, “Starting on HIV medicines is like trying on shoes—there’s a good chance the first one you try won’t be a perfect fit.” That’s OK, he says, because changes can be made. “They should be very comfortable, since we want you to use them every day.”
ABOUT THOSE SIDE EFFECTS
Like any drugs, HIV treatments can have side effects—at least part of
the time. Some people don’t experience any side effects; others
experience them but find them tolerable, whereas some end up switching
meds because of the side effects. Fortunately, ARV
treatments—especially the newer agents—are much better tolerated than
earlier predecessors.
Talking with your health care provider and doing some homework (visit AIDSmeds.com) ahead of time about potential side effects can reduce
your anxiety and ensure that if you do have a side effect you’ll know
what to do about it.
You should take a regimen you think you can live with. This is where
careful communication with your health care provider comes in handy.
First you should consider your medical history. Do you have a history
of cardiovascular, liver or kidney disease? What about diabetes? Have
you ever suffered from depression? Do you know if you’re allergic to
any medications? What are your plans for starting or continuing a
family? Answering these questions with your health care provider will
help you both pick a regimen that may be less likely to cause side
effects—or minimize the severity of a side effect if it occurs.
You may also want to prepare for certain side effects. HIV medications
can sometimes cause nausea, stomach discomfort and diarrhea. These can
frequently be managed with medications bought over-the-counter at your
pharmacy or grocery store. Other side effects—including vivid dreams,
muddled thinking and skin discoloration—may be more difficult to manage
but usually go away on their own.
Of course, you should allow yourself time to get used to HIV treatment
once you’ve started. But if you’re concerned about a possible side
effect or not feeling well after starting a new regimen, don’t hesitate
to contact your health care provider for advice.
