Today we know for certain that starting HIV meds as soon as possible after diagnosis can boost health and prolong life. But whether you’re just starting meds, considering a switch or dealing with pesky side effects, the best tool on your side is open and honest dialogue with your health care provider. “It’s when both the doctor and the patient are totally up-front and open to each other’s concerns and priorities that we see the best long-term results,” says Antonio Urbina, MD, medical director for HIV/AIDS Education and Training at New York City’s Mt. Sinai Hospital. So when talking about treatment, keep in mind the following:
Many HIV drugs come with side effects, although most of the time they are not serious, and they often go away after a few weeks. Overall, the newer HIV drugs come with vastly fewer side effects than they did 10 or 20 years ago. When discussing starting or changing HIV meds with your provider, ask these questions: 1) What are the short- and long-term side effects of the drug? 2) Are you more likely to experience side effects because of other health issues, such as depression or high cholesterol? and 3) How can possible side effects be prevented or treated? “Every side-effects issue can be resolved as long as you report them to your doc as soon as they occur,” Urbina says.
HIV meds can have bad interactions with other drugs, including other HIV meds, anti-cholesterol meds, antidepressants, supplements like St. John’s wort, and alcohol and recreational drugs like ecstasy or crystal meth. These interactions can cause drug levels to swing in your bloodstream, either dropping too low, which may increase your risk of resistance, or rising too high, which increases risk of toxicity. Thankfully, most of these interactions are well known. “That’s why it’s super-important that you’re up front with your doctor about any other drugs you’re on, from prescribed ones to over-the-counter ones to alcohol, pot or party drugs,” Urbina says. “We can’t help you unless we know everything you’re on, so don’t be ashamed to tell us anything. We can also help if you’re self-medicating other problems like depression, or if you’re addicted to something. But you have to be honest.”
Certain HIV meds are contraindicated, meaning that they should not be taken if you have other health issues. For example, you might not want to take Viread (tenofovir disoproxil fumarate, or TDF), which is in Truvada and Atripla, if you already have kidney problems. And you might want to avoid Sustiva (efavirenz), which is also found in Atripla, if you have a history of severe depression. “Again,” Urbina says, “that’s why it’s so important that you’re completely up front about all your issues so that we can find the best HIV meds for you.”
It’s important to take your medications on schedule as prescribed by your health care provider. If you miss your HIV meds often enough, the virus can develop resistance to them and they will lose their effect-iveness. That’s another reason to be honest with your provider. If you can’t or won’t take your meds as prescribed, talk to your doc. “We can work something out so that you’re getting good treatment you can deal with—as long as you’re honest with us,” Urbina says. Ask about ways to improve your adherence and check out the adherence tips at POZ.com.
Sometimes you might want to switch meds because you’re having trouble with the ones you’re on, or you hear that a new HIV drug has come out. Or your doctor might recommend that you switch because another option has a better long-term side-effect profile or is easier to take. “Either way,” Urbina says, “let’s have an honest talk and ask each other why we want this switch and why this switch makes sense. Just because there’s a hot new med out, it may not be the best choice for you, especially if you’re happy with what you’re on.”
Doing Your Homework
There’s so much information online these days about HIV meds, and it changes all the time. Never assume that your doctor knows everything— and don’t be afraid to show your provider any information you found online. “If you’ve heard or read something you think might improve your treatment or your health, let us know,” Urbina says. “We can always talk it out and maybe make changes accordingly.”
Click here to download a PDF of a handy checklist you can use to kick-start a conversation with your doctor.