- What You Need to Know About HIV
- HIV Treatment
- Handling the Side Effects of HIV Meds
- Talking about HIV
- HIV Meds and Heart Health
- HIV Meds and Heartburn
- HIV Meds and Lipids
- Questions to Ask Your Doctor
- Tips to Work With Your Healthcare Team
HIV Treatment
[ What Is HIV Treatment? ] [ What Is Combination Therapy? ] [
Choosing Your Physician ]
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Starting and Staying on Treatment ] [
Treatment Goals ] [
How Do Your Know Your Meds Are Working? ] [
Because You Will Not Give In ] [
Sources ] [
Indication ] [
Important Safety Information ]
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HIV treatment is the use of HIV meds (“antiretroviral drugs” or “ARVs”) to target the virus’s ability to make copies of itself, to slow down the disease and therefore help to keep an HIV-positive person healthy. In addition to meds that target HIV specifically, you may also have HIV treatment that includes medicines to keep you from getting infections or illnesses (“prophylactic” medicines) and/or medicines to treat infections or illnesses you may already have. This section focuses specifically on those HIV treatment meds that target the virus in an effort to reduce your viral load and increase your CD4 cell count (T cells).
To reduce the amount of virus in your bloodstream, HIV treatment meds from different classes target the virus in different ways and at different stages of its replication cycle (the way the virus makes copies of itself). The four classes of HIV meds are:
- Fusion inhibitors (FIs)
- Nucleoside reverse transcriptase inhibitors (“Nukes” or NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (“Non-nukes” or NNRTIs)
- Protease inhibitors (PIs)
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- HIV attaches to and enters the CD4 cell. The CD4 cell is an important part of the immune system, which is the body’s defense against infections and diseases. FIs work here.
- HIV uses the reverse transcriptase enzyme to transfer its RNA (transmitter of genetic information). NRTIs and NNRTIs work here.
- Viral DNA enters the cell’s nucleus (control center) and inserts its genetic information, which tells the cell to make copies of the virus—turning the cell into an “HIV factory.”
- The protease enzyme makes viral parts into a complete virus. This new HIV leaves the cell to infect more CD4 cells. PIs work here to stop this process and prevent new HIV from being made.
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Combination therapy uses different antiviral meds to target HIV at different stages of its life cycle and slow the ability of HIV to make copies of itself (“replicate”). Greater amounts of virus in the body can mean that HIV disease will progress more rapidly.
The goal of treatment is to slow HIV replication as much as possible for as long as possible. When the amount of virus decreases in the body, there should be an increase in CD4 cells, which can mean an improvement in how well your immune system works.
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Your comfort level with and confidence in your care are very important when choosing your healthcare provider(s). To get the most out of your treatment, it is important that you work with a healthcare provider who is familiar with HIV/AIDS . It is in your best interest to see a specialist who keeps up with current HIV treatment options and strategies. A specialist will know about the safety records of approved HIV treatments and can also manage other health concerns, some of which may be affected by or related to HIV infection or its treatment: high cholesterol, stomach-related problems (like diarrhea), liver problems, etc.
If you are an HIV+ woman of childbearing years, your healthcare provider should also know the latest HIV treatment guidelines for women who are pregnant or may become pregnant. Many medicines, including HIV medicines, are not recommended for use during pregnancy. With any treatment, you and your doctor must weigh the risks and benefits before making a decision. Some HIV medicines have more information about their use during pregnancy and that information should be a part of your decision-making process.
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Starting and Staying on Treatment
Experts tend to agree that people experiencing certain HIV-related infections or symptoms should start treatment. In general, an increasing viral load and a decreasing CD4 cell count (below 350 cells/mm 3) can mean that it is time to consider antiviral treatment. But there is a lot of debate about when it is best to begin HIV treatment, and there are additional factors to consider:
- Are you ready to begin a combination treatment regimen?
- Do you have ongoing drug and alcohol use, depression or other issues that may get in the way of your ability to take your meds as prescribed?
- Is your daily life set up in a way that supports your decision to begin treatment?
- Do you have other health conditions or are you at increased risk for other health conditions (for example, heart disease, diabetes, hepatitis B or C, etc.)?
- Do you have health issues you sometimes treat with prescription or over-the-counter medicines (for example, heartburn and stomach upset, high cholesterol ,etc.)?
In general, taking care of your overall health and well-being—which can include caring for your mind, body and spirit—can help you manage HIV. Nutrition, exercise, holistic therapies, a spiritual practice, regular social interaction, mental healthcare or any other supportive, healthy habit can have significant benefits for someone living with a long-term illness—including HIV.
If you decide to begin HIV treatment, one thing is clear: it is crucial that you take your meds exactly as prescribed to avoid developing resistance that will weaken the effect of your meds and limit your future HIV treatment options. If you decide that you can’t handle your meds—for any reason—it is generally a good idea to talk with your doctor first before stopping your meds.* Your doctor can help you decide what else you can do, how you can better handle side effects or change your regimen (if these are issues) and help you keep your options open.
*Make sure you are aware of possible allergic reactions to all of your meds and know how to handle such reactions—which may include stopping your meds immediately.
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Being proactive and taking steps to care for your overall health and manage HIV can make a real difference. Keeping you as healthy as possible by lessening the effects of HIV on your immune system is the main goal for you and your doctor, which means:
- Keeping the amount of HIV in your blood as low as possible for as long as possible.
- Increasing or stabilizing the number of your CD4 cells (CD4 cells help you stay healthy by fighting infections).
- Keeping your meds working for as long as possible by lowering the risk of HIV developing resistance—which means taking your meds exactly as prescribed.
For more on the goals of HIV treatment, talk with your doctor. You can also read the treatment guidelines published by the Department of Health and Human Services (DHHS). The guidelines are written for a physician audience, so talk with your doctor if you have questions.
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How Do You Know Your Meds Are Working?
In general, your viral load is the most important sign that your treatment is working. Other important factors are:
- CD4 cell count
- Recent health history ( how you are feeling)
- Results of physical examinations
Your viral load should be checked after you start treatment and checked regularly (as determined by your doctor) to make sure your meds are still working. When HIV meds are active and working, your viral load should decrease and continue to decrease—with the goal of getting to undetectable—as long as you take your meds. If your viral load is still detectable after several months of treatment, you should talk with your doctor about possibly changing your meds.
Please note that, in general, treatment decisions are not made based on one test result, but are made after considering a trend in the results (for example, a viral load that continues to increase or goes up and down a lot).
It is important to remember that many factors can impact how fast or how much your viral load decreases. These factors include: your baseline viral load and CD4 cell count (before starting your regimen), whether you have used HIV meds before, whether you have any HIV- or AIDS-related infections or illnesses or how closely you have followed (adhered to) your therapy. Talk with your doctor if you are concerned about the results of your viral load tests.
CD4 cell counts may also help show how well your meds are working and are a sign of how well your immune system is working. After starting HIV treatment, your CD4 cell count should be checked regularly as determined by your doctor. Talk with your doctor if you are concerned about your CD4 cell count.
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You have many reasons to consider treatment to fight HIV. And you know that your knowledge is your power. For more information about HIV treatment, you can visit several Web sites that focus on HIV meds:
NUMEDEX
Project Inform
AIDSmeds.com
The Body
AEGIS
This site also has information about other resources and about INVIRASE® (saquinavir mesylate)—a protease inhibitor that may work for you.
Protease inhibitors are a powerful class of HIV treatment; boosted INVIRASE controls HIV and is generally well tolerated with a low rate of stomach-related side effects and is considered one of the very few lipid-friendly PIs. INVIRASE also has a longterm record of safety with more 10 years of study and experience, including more than one million prescriptions since it was approved for treatment.
As with any treatment decision, you should ask your doctor questions and talk with her or him when making these decisions. Complete product information about INVIRASE is also available on this Web site.
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The information provided here is based on information found at the following Web sites:
US Department of Health and Human Services (DHHS)
The Body
Project Inform
AEGIS: AIDS Education Global Information System
For additional information, please visit the resources section of this Web site.
This information does not include everything you may need to know about HIV and does not take the place of talking with your healthcare provider.
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