Starting HIV Treatment

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First Things First

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. It may be helpful to focus on how:

  • 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). There is no need for you to 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) or check out our online support community, A Girl Like Me. 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 do not enjoy things that you used to enjoy, you may be depressed. If you are depressed or feeling low, it is important to talk with your provider and get the support you need. The same goes for any issues you have with substance use or abuse. Taking care of problems with depression or substance use can really help you take your HIV drugs regularly and be as healthy as possible.

It is important for you to tell your health care provider if you have other health problems, are taking any other drugs (including over-the-counter medications, vitamins or supplements, or street drugs), are using any alternative or complementary therapies, or are in any recovery programs. This is important information that may affect your HIV treatment options. In addition, discuss family planning with your health care provider since HIV drugs can interfere with some birth control methods and pregnant women should not take certain HIV drugs.

Choosing an HIV Drug Regimen

The next step is for you and your health care provider to choose a drug regimen. Currently, there are 32 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
  • An integrase inhibitor 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 called Norvir (ritonavir); this makes the first PI work better]

More information about which drugs to take can be found in the US government's treatment guidelines or the World Health Organization's guidelines.

Resistance

With any HIV regimen, a major problem can be the development of resistance. When HIV makes copies of itself (reproduces), it can make changes, 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. Your viral load can increase quickly if resistance occurs, and you may have to switch drug 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 fewer treatment choices you have.

Resistance Tests

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

  • People who have just become infected with HIV, whether or not they are going to take HIV drugs right away
  • People who have never taken HIV drugs and are starting to receive medical care, whether or not they are going to take HIV drugs right away
  • People who have never been on HIV drugs and are planning to start
  • People who are on HIV drugs and see their viral load go up
  • People who have recently started HIV drugs and their viral load is not coming down enough
  • Pregnant women living with HIV whose viral load is not as low as it should be

Sequencing

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

Adherence

The best way to prevent resistance is with good adherence. Adherence means taking your HIV drugs exactly as directed. 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.

Dosing Schedule

It will be easier to adhere to your regimen if you set up a dosing schedule that works for you. A dosing schedule is simply a plan for when you take which drugs each day. Ask your health care provider the following questions:

  • How many pills are in a dose?
  • How many times a day should each dose be taken?
  • Are there any food requirements (for example, take on an empty stomach or take with food)?
  • Are there any drugs or supplements that may interfere with how this HIV 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. It is also important to plan for weekends and holidays by making sure you have enough of your HIV drugs to last while drug stores are closed or if you go out of town.

You can track how well you are taking your pills by keeping a journal or chart. Remember that everyone makes mistakes. When this happens, it is important to start again and commit to staying on track. 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.

Taking Your Pills

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

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

Side Effects

All HIV drugs have some side effects (but not all people experience side effects). Side effects are one of the major reasons that people do not stick to their HIV regimen. It is best to be prepared by asking your health care provider about the possible short- and long-term side effects of your particular drug 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 might 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, it is important that you not stop your HIV drugs unless advised to do so by your health care provider. On the other hand, there is no need to 'grin and bear it.' Instead, contact your health care provider and talk to her or him about ways to deal with the side effects. Your provider may suggest switching to another drug combination.

Putting It All Together

Now you are 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 be successful with your HIV treatment.

Checklist to discuss with my provider:

  1. Other medications I am taking, including over-the-counter, herbal, and street drugs
  2. Substance use (drug 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 take them?
    • How many pills are in one dose?

Additional Resources

Select the links below for additional material related to starting HIV treatment.

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