The currently available HIV antiviral drugs can improve the quality of life of someone infected with HIV, and help them to stay well much longer than they otherwise would. The drugs slow down the reproduction and progression of HIV in the body but it needs to be remembered that they are a treatment and not a cure.
Some people find it easy to make up their mind about treatment. For others, making a decision may take considerable time, and having many options may feel very confusing. It is important to get a balanced view about the treatment issues. If you know the positive and negative effects of the treatment, it can help you to make the right decision.
There is no proven 'right' time to start HIV treatment. It is helpful to get some basic tests done to monitor the course of your HIV infection. Then your doctor can advise you about the timing of starting treatment. There are different views of the benefits of starting HIV treatment earlier or later. Either choice will have long-term effects and consequences. You also have to consider whether you are ready to start treatment or not. Commitment to the treatment is as important as the drugs themselves.
There are certain tests which can give you information that can help you to decide about treatment, in particular the CD4 test and the viral load test.
The CD4 Test
HIV attacks a type of immune system cell called the T-helper cell. This cell carries on its surface a protein called CD4, which HIV uses to attach itself to the cell before gaining entry.
The T-helper cell plays an important part in the human immune system. It helps to co-ordinate all the other cells to fight illnesses. A major reduction in the number of T-helper cells can have a serious effect on the immune system.
HIV infected cells are often damaged or destroyed. As a result, there are fewer cells available to help the immune system to fight illnesses.
The CD4 test measures the number of T-helper cells in your blood. The more cells you have per cubic millimetre of blood, the stronger is your immune system. The stronger your immune system, the better your body can fight illnesses. A low CD4 count does not mean that you will certainly become ill, but it makes it more likely.
In the UK, it is recommended that all patients with a CD4 count consistently below 200 cells per millimetre of blood should start antiretroviral therapy. However, data suggest that it is better to take action before the count has fallen so low. The general recommendation in the UK is for treatment to begin when the CD4 count is between 200 and 350. Details of the various treatment guidelines can be found in our links section.
The Viral Load Test
Viral load refers to the amount of HIV in your blood.
Like the CD4 test, the viral load test can provide important information about the likely course of HIV infection. There are different viral load tests available, which use a variety of techniques to measure the amount of virus. The results of these tests tell you whether your viral load is low, medium or high.
Starting treatment
Viral load and CD4 tests can help you to decide whether to start treatment or not. You should talk to your doctor about the results of the tests and what they indicate. The anti-HIV drugs should reduce viral load to a level which is below the level of detection of the current tests, and the drugs should also boost CD4 levels.
After considering the results of the tests, you can find out from your doctor about the various HIV drugs and combinations available, and which are suitable, including the positive and negative effects the drugs have.
You should start the treatment only when you are really ready. You need to be very committed, since following a drug regime can be quite demanding. Your commitment to the treatment is as important as the drugs themselves. Once the treatment is started, it is likely to be for life. So only start treatment when you feel that you can really be committed to it.
The best combination
For most people, there are a number of drug combinations available that might work as there are 4 different groups of antiretrovirals and more than 20 approved individual drugs. Your doctor should be able to suggest the best combination for your CD4 count and viral load. It can be hard to tell which is the best combination, since a combination that suits one person might not suit another.
It is important that the combination of drugs works medically. What is also important is that the drugs can be taken well and on time. It is essential to consider the restrictions and limitations that the drugs may have on your lifestyle.
These are some of the issues that need to be considered:
- How many pills are there and how many times a day do they have to be taken?
- Are there any food restrictions?
- What are the possible side-effects?
- Are there other drugs or complimentary therapies that cannot be used?
- What is the size of the pills?
- Are there any special handling requirements?
Usually the drugs must be taken twice or three times a day, depending on the combination, although there are starting to be more combinations that only need to be taken once a day. Some of drugs have food restrictions, which have to be followed carefully. Some anti-HIV drugs have known side effects. The side-effects can have a considerable effect on every day living and activities. Also, the size of some of the larger drugs can be a problem. Some antiretroviral drugs require special handling, such as refrigeration, and for some people this may cause problems.
The first time you use antiretrovirals is when they are most effective. This is why you should try to get the combination right first time.Pregnancy & treatment
Many studies have shown that anti-HIV drugs can be used during pregnancy. The drugs can be used to reduce a woman's viral load effectively below detection. This also significantly reduces the risk of mother to child transmission.
Find out more about HIV and pregnancy.
Adherence
The term adherence means taking the drugs exactly as prescribed. It also means taking the drugs on time and following any diet restrictions.
Adherence can feel difficult and sometimes there is a need to make changes to your lifestyle to adjust to the treatment. Developing a routine can help you to keep up with your daily drug regime.
If you are starting combination therapy, it is important to concentrate on getting used to the drug regime. Give yourself some time and space to get it to work.
If the drug treatment instructions are not followed, it is likely that the drugs will not be absorbed properly in the body. This will have serious short- and long-term consequences. It will have an effect on the viral load. It is also likely that you may develop resistance to certain drugs. This will reduce the overall benefits from the drugs in the future.
It is therefore important that you are committed to your treatment and try to make it work as a part of your lifestyle.
More information
AVERT.org has information about Continuing Treatment, as well as an Introduction to HIV and AIDS treatment.
Last updated July 29, 2005
