When you and your health care provider decide the time is right for you to start treatment, there are things you can do to set yourself up for success. The first step is to think positively. Having the right attitude going in will help you get the most out of your treatment. Remind yourself that:

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

It takes a lot of commitment to stick to a treatment regimen (combination of HIV drugs). Don’t go it alone. Your health care provider is an important support and so are other people such as nurses, social workers, therapists, and case managers. You may want to join a support group for people living with HIV (HIV+ people). Family and friends can help too.

It can be tough to stick with a treatment regimen if you need to work on other issues in your life. If you feel down a lot of the time, and don’t enjoy things that you used to enjoy, you may be depressed. That’s an issue that should be addressed before you start HIV drugs. The same goes for a substance abuse problem.

Tell your health care provider if you have other health problems, are taking any other medications (including over the counter, herbal, alternative, and street drugs), or are in any recovery programs. This is important information that may affect your treatment options. In addition, discuss family planning with your health care provider since HIV drugs can interfere with birth control pills and pregnant women should not take certain HIV drugs.

The next step is for you and your health care provider to choose a drug regimen. Currently, there are close to 30 drugs approved for HIV treatment. They are grouped into five classes:

• Entry inhibitors (includes fusion inhibitors and CCR5 antagonists)
• Integrase inhibitors
• Nucleoside/nucleotide reverse transcriptase inhibitors (“nukes” or NRTIs)
• Non-nucleoside reverse transcriptase inhibitors (“non-nukes” or NNRTIs)
• Protease inhibitors (PIs)

There are many ways to combine the drugs, but experts recommend that people who have never taken HIV drugs before start with one of the following combinations:

• An NNRTI plus 2 NRTIs or
• A PI plus 2 NRTIs (in most cases the PI should be combined, or “boosted,” with a small dose of a second PI; this makes the first PI work better)
  

More information about which drugs to take can be found in the US government’s treatment guidelines (see links in “Additional Resources” on the right).

With any HIV regimen, a major problem can be the development of resistance. When HIV makes copies of itself (reproduces), it can make mistakes, called mutations. Some mutations prevent certain HIV drugs from working. When this happens, we say that HIV has become “resistant” to a particular HIV drug. Viral load can increase quickly if resistance occurs and you may have to switch regimens.

In addition, if you become resistant to one drug, you become resistant to other drugs in the same class. This is known as cross-resistance. The more drugs you are resistant to, the less treatment options you have.

Before starting HIV treatment, it is important that your health care provider gives you a resistance test to find out if you have drug-resistant HIV. This helps determine which drugs will work best for you. The treatment guidelines recommend resistance tests:

• For all HIV+ people when they enter into care
• For those who are planning to change HIV drugs
• For those whose treatment is not working (for example, viral load is going up or not decreasing very much while taking HIV drugs)
• For all pregnant women prior to starting HIV drugs

One of the strategies in HIV treatment is to think ahead. We know that drugs may stop working because of resistance and cross-resistance. So when you and your health care provider choose your first regimen, you should discuss which drugs could be used in future regimens. This process is called sequencing. It ensures that you will have other treatment options available if resistance develops.

The best way to prevent resistance is with good adherence. Adherence means taking your HIV drugs exactly as they are prescribed. This gives the drugs the best chance of working well to block HIV reproduction. The less HIV can reproduce; the less likely it is to develop mutations that can lead to resistance.

It will be easier to adhere to your drugs if you set up a dosing schedule that works for you. Ask your health care provider the following questions:

• How many times a day should each dose be taken?
• How many pills are in a dose?
• Are there any food requirements, for example, take on an empty stomach or take with food?
• Are there any medications or supplements that may interfere with how this drug works?

Then make your plan. If you take drugs in the morning, pick something that you do every morning, like brushing your teeth or having a cup of coffee. Take your drugs at that time.

If your drugs are twice a day or only in the evening, pick a reminder at night. Maybe you always watch the 11:00 news or have a cup of tea before you go to bed. Whatever you do, add your drugs to your routine!

If you have children, make sure your pill-taking schedule fits in with their routines as well as your own.

Track how well you are taking your pills by keeping a journal or chart. Remember that everyone makes mistakes. When this happens, you just need to start again and commit to staying on track. But if you start missing doses on a regular basis, tell your health care provider. He or she can help you identify the problem and come up with a solution.

If no one knows about your HIV status, taking medications is going to be more difficult. You may feel like you have to hide your pill bottles or sneak out of the room when it’s time for your dose. These challenges make it harder to take your drugs.

This may be a good time to tell the people close to you about your HIV status. But if you’re not ready, put everything in a pillbox and tell people you take vitamins or medicine for another condition.

All HIV drugs have some side effects (but not all people experience side effects). Side effects are one of the major reasons that people don’t stick to their HIV regimen. Be prepared! Ask your health care provider about the possible short- and long-term side effects of your particular regimen.

There are medicines that can be used to treat short-term side effects like nausea and diarrhea. Ask your health care provider to recommend some things you can do to reduce or manage side effects. If you may need medication to manage side effects, you should have a supply on hand before you start your HIV drugs.

If you are having side effects, don’t stop your HIV drugs until you contact your health care provider. Suddenly stopping your HIV drugs could have serious health consequences. Talk to your health care provider about ways to deal with the side effects, including switching to another drug combination.

Now you’re ready to go! As you get started, have faith in your ability to stick with your drug regimen. Also, keep asking questions! The more you know, the better equipped you are to successfully tackle HIV treatment.

1. Other medications I am taking, including over the counter, herbal and street drugs
2. Substance use (drugs or alcohol) issues
3. Whether I am pregnant or plan to get pregnant
4. If I feel depressed or have experienced mental health issues in the past
5. What my support system is like and whether I need additional support
6. Resistance testing
7. Issues/barriers I might have taking my drugs on time every day
8. The dosing schedule of the HIV drugs I will be taking:
   • Are there food requirements?
   • What are the side effects?
   • How many times a day do I need to take them?
   • How many pills?