HIV drugs can improve quality of life and help HIV+ people stay healthier longer. But starting treatment is a big decision. In order to get the maximum benefit from the drugs, you need to make a commitment to taking them correctly. Commitment to the treatment is as important as the drugs themselves. So before you get started, make sure that you are ready to stick to it for the long haul! This takes a combination of the right doctor, enough knowledge about HIV, and the right attitude.

You and your doctor are a team working together to make the best treatment decisions for you. Ask yourself a few questions: Can I be totally honest with my doctor? 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’d like to ask your doctor before you go to visits. Answer your doctor’s questions with the truth, not with what you think the doctor wants to hear. If that still doesn’t work, it may be time to find another doctor.

It is also wise to have an HIV specialist for your care. Doctors who devote most of their time to HIV are best equipped to manage this complicated condition.

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 invaders. When the immune system loses too many CD4 cells, it becomes weak and is unable to fight off germs. At this point, you are vulnerable to AIDS-related opportunistic infections (OIs) that can cause serious illness or death.

Scientists have developed drugs that block HIV from reproducing (multiplying) at different stages of its life cycle. So far there are four classes of drugs:

• Fusion inhibitors
• Nucleoside/nucleotide reverse transcriptase inhibitors (“nukes” or NRTIs)
• Non-nucleoside reverse transcriptase inhibitors (“non-nukes” or NNRTIs)
• Protease inhibitors (PIs)

These drugs are always used in combinations known as HAART. HAART stands for highly active antiretroviral therapy. HAART attacks HIV at different points using different drugs (usually from different classes). This is the best way to reduce the amount of HIV in your blood (viral load).

Your doctor will use blood tests to monitor how you are doing. The CD4 count checks the strength of your immune system. The viral load test measures the amount of virus in your blood. When you use HIV drugs, you should see your viral load go down and your CD4 count go up. That’s how you can tell the medications are working.

• To get viral load as low as possible for as long as possible
• To preserve or regain immune system function by increasing CD4 cells
• To improve quality of life and reduce illness and death

The government has put together a list of guidelines to help people decide when to start treatment:

• Anyone with symptoms of AIDS (such as opportunistic infections) should start therapy
• Anyone with a CD4 count less than 200 should start therapy
• People with a CD4 count greater than 350 and viral load less than 55,000 can probably hold off on treatment

The guidelines are less clear in other situations. You and your doctor should review your numbers frequently and consider the risks and benefits of starting treatment earlier or later.

Benefits of Starting Early:

• Earlier and easier reduction of viral load
• Delay or prevent a weakened immune system
• Stay healthier longer

Risks of Starting Early:

• It can be hard to take drugs everyday
• Drug-related side effects
• May reduce future treatment options
• No one knows how long the drugs will keep working

Benefits of Starting Later:

• Avoid negative effects on quality of life
• Avoid drug-related side effects
• More treatment options for the future

Risks of Starting Later:

• May have immune system damage that cannot be reversed or improved
• May be harder to bring down viral load

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 becomes less effective against HIV, we say that HIV has become "resistant" to that drug.  If you develop resistance you will have to change one or more drugs in your regimen.

In order to get the maximum benefit from HIV therapy and reduce the chances of developing resistance, you must take your drugs on schedule. This is called adherence. 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.

If you decide the time is right to start treatment, have a good attitude going in. Believe that:

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

What ever decision you make, don’t go it alone. Put together a support system including your doctor, nurses, social workers, and case managers. You may want to join a support group of other HIV+ people. Family and friends can help too.

The more you think and talk about your decision, the better the outcome. What ever you decide to do, keep going to your doctor for regular check ups and blood work.

1		Peiperl, L. & Coffey, S. (2003). Overview of antiretroviral drugs: Retrieved July 2003 from http://hivinsite.ucsf.edu/InSite.jsp?page=ar-drugs.
2		Sterling, T. (2003). When to start HAART, and what to start. Hopkins AIDS Report: Retrieved July 2003 from http://hopkins-aids.edu/publications/report/mar03_4.html.
3		U.S. Department of Health and Human Service AIDSInfo. (2004). Antiretroviral treatment: Adult and adolescent guidelines: Retrieved July 2003 from http://aidsinfo.nih.gov/guidelines/default_db2.asp?id=50.