HIV: Should I start taking antiretroviral medicines for HIV infection?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Start antiretroviral medicines before your CD4+ cell count is
below 350 or you have symptoms of HIV or AIDS.
Don't start medicines until your CD4+ cell count is below 350
or you have symptoms. Have regular blood tests to check your levels of HIV and
your CD4+ cell count.
Key points to remember
When taken as prescribed, antiretroviral
medicines can prevent AIDS. And they can help keep your
immune system healthy and help you live longer.
You may need to take antiretroviral medicines even if you don't
have symptoms of HIV. Experts recommend starting treatment if you have low
levels of
CD4+ cells, are pregnant, or you have or are at risk
for other health problems.
You may not need to start treatment
right away if your CD4+ count is at a healthy level.
You need to
take medicine every day. If you can't take your medicine as prescribed and you
miss doses, HIV may become
resistant to the medicine and harder to treat.
These medicines can have serious side effects. Some people are
not bothered by the side effects. Other people stop taking their medicines
because they feel too sick to take them.
If you're pregnant,
medicines can help keep your unborn baby from getting HIV.
Whether
or not you start treatment, you'll need to have blood tests every few months to
check your levels of HIV and your CD4+ cell count.
HIV stands for
human immunodeficiency virus. Most people get HIV when they have unprotected
sex or share needles with someone who has the virus.
The virus
attacks and weakens your
immune system, which is your body's natural defense
against infection. HIV infects certain
white blood cells called
CD4+ cells. If too many of these cells are destroyed
or weakened, your immune system is less able to fight infection and
disease.
HIV infection can lead to
AIDS (acquired immunodeficiency syndrome). People with
AIDS have a low number of CD4+ cells and get infections and some cancers that
rarely occur in healthy people. These can be deadly.
If HIV is
diagnosed before it becomes AIDS, medicines can help keep your immune system
strong and healthy. With treatment, many people with HIV are able to live long
and active lives.
A
combination of three or more antiretroviral medicines, called
highly active antiretroviral therapy (HAART), is the
main treatment for HIV. It can slow the rate at which the virus multiplies,
prevent AIDS, and keep your immune system much healthier than if you used just
one kind of medicine.
The goal of treatment is to reduce the amount
of virus in your body so that it can no longer be found in your blood.
There are several medicines that are most often combined to treat HIV.
They are sorted into five groups:
Protease inhibitors (PIs), such as
atazanavir, saquinavir, ritonavir, indinavir, nelfinavir, fosamprenavir,
lopinavir/ritonavir, tipranavir, and darunavir
You can now get some of these medicines combined into one
pill. So you may only have to take one or two pills a day.
Experts
recommend starting treatment if you have low levels of
CD4+ cells (lower than 350), are pregnant, or you have
or are at risk for other health problems. Medicines can help stabilize and
increase the number of CD4+ cells in your body. And they can prevent
AIDS.
HAART doesn't
cure HIV. But people who take these medicines as prescribed:
Avoid getting
AIDS, or recover from the symptoms of AIDS and enjoy a
return to better health.
Have fewer infections that are common in people whose immune
systems are weak, such as
pneumonia and certain types of cancers. These are
called
opportunistic infections.
See a major drop in the amount of virus in their body, often to
a level where it can no longer be found in their blood.
Have a
stable or slowly increasing CD4+ cell count.
For the medicine to work, you need to take it every day.
If you can't take your medicine as prescribed and you miss doses, HIV may
become
resistant to the medicine and harder to treat.
Antiretroviral medicines can have serious side effects. Some people stop
taking their medicines because they feel too sick to take them. But it's
important that you continue to take them, because these medicines can help keep
the virus under control and keep your immune system healthy.
If you
can't take your medicine as prescribed and you miss doses, HIV may become
resistant to the medicine and harder to treat.
Some side effects, such as nausea, may improve when your body adjusts to
the medicines. If you have problems taking your medicines, talk with your
doctor. There are medicines you can take to treat the side effects.
Side effects of some antiretroviral medicines may include:
Nausea and
vomiting.
Diarrhea.
Fever.
Fatigue.
Headache.
Dizziness.
Belly
pain.
Trouble sleeping.
Certain antiretroviral medicines may also cause more
serious medical problems, such as a buildup of acid in your blood, and changes
in the way your body stores fat and uses sugar.
Personal stories about starting antiretroviral medicine
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My cell
counts and viral load are still better than the ranges where most doctors would
offer me treatment. I'm still worried about taking medicine every day, but
these medicines sound like my best hope of living so I can see my daughter grow
up and get married.
Marla, age 30
I put off
taking medicine for HIV for as long as I could, but when my CD4+ cell count
dropped to 350, I decided that it was time to start. The medicines made me feel
dizzy and sick at the beginning, but they are helping my immune system get
stronger. I am feeling a little better every week.
Ted, age 45
I know
several people who were feeling just fine but started HAART and got really
sick. Right now, even though my cell counts are getting close to the
"treatment" ranges, I'm not ready to start taking medicines. I haven't ruled
out taking them later on, but for now I'm going to do the best I can to stay
healthy and appreciate every day that I'm not sick.
Greg, age 38
The past few
years have been a really exciting time for people with HIV infection. I've
followed the research pretty closely, and it sounds like every few months we
know a little bit more about how best to fight this disease. I know that the
newer medicines have fewer side effects than the older medicines, and people
are getting treated earlier and earlier. I'm hoping that the medicines will get
even better by the time my numbers get into the recommended treatment range. In
the meantime, I'm going to take very good care of myself, eat well, exercise,
and try to avoid infections.
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take antiretroviral medicines
Reasons not to take antiretroviral medicines
I want to do everything I can to avoid getting AIDS and to live a long and healthy life.
I don't want to start taking medicine until I have to.
More important
Equally important
More important
I'm worried that I might spread HIV to others if I don't treat the infection.
I'm not worried about spreading HIV to others.
More important
Equally important
More important
I'm not worried about the side effects of treatment.
I don't think I could handle the side effects of treatment.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking antiretroviral medicines
NOT taking antiretroviral medicines
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
Check the facts
1.
Even though I don't have symptoms of HIV, I may still need to take medicine.
TrueThat's right. Experts recommend starting treatment if you have low levels of CD4+ cells, are pregnant, or you have or are at risk for other health problems.
FalseSorry, that's not right. Experts recommend starting treatment if you have low levels of CD4+ cells, are pregnant, or you have or are at risk for other health problems.
I'm not sureIt may help to go back and read "Why might your doctor recommend starting antiretroviral medicines?" Experts recommend starting treatment if you have low levels of CD4+ cells, are pregnant, or have other health problems.
2.
Antiretroviral medicines can help me stay healthy and prevent AIDS.
TrueThat's right. When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.
FalseSorry, that's not right. When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.
I'm not sureIt may help to go back and read "Key points to remember." When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.
3.
For the medicine to work, I need to take medicine every day.
TrueThat's right. You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
FalseSorry, that's not right. You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
I'm not sureIt may help to go back and read "How well do these medicines work?" You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become harder to treat.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
U.S. Department of Health and Human Services (2008). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Hammer, Scott M, et al. (2008). Antiretroviral
treatment of adult HIV infection: 2008 recommendations of the International
AIDS Society USA Panel. JAMA, 300 (5):
555–570.
HIV: Should I start taking antiretroviral medicines for HIV infection?
You can use this information to talk with your
doctor or loved ones about your decision.
Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?
1. Get the Facts
Your options
Start antiretroviral medicines before your CD4+ cell count is
below 350 or you have symptoms of HIV or AIDS.
Don't start medicines until your CD4+ cell count is below 350
or you have symptoms. Have regular blood tests to check your levels of HIV and
your CD4+ cell count.
Key points to remember
When taken as prescribed, antiretroviral
medicines can prevent AIDS. And they can help keep your
immune system healthy and help you live longer.
You may need to take antiretroviral medicines even if you don't
have symptoms of HIV. Experts recommend starting treatment if you have low
levels of
CD4+ cells, are pregnant, or you have or are at risk
for other health problems.
You may not need to start treatment
right away if your CD4+ count is at a healthy level.
You need to
take medicine every day. If you can't take your medicine as prescribed and you
miss doses, HIV may become
resistant to the medicine and harder to treat.
These medicines can have serious side effects. Some people are
not bothered by the side effects. Other people stop taking their medicines
because they feel too sick to take them.
If you're pregnant,
medicines can help keep your unborn baby from getting HIV.
Whether
or not you start treatment, you'll need to have blood tests every few months to
check your levels of HIV and your CD4+ cell count.
HIV stands for
human immunodeficiency virus. Most people get HIV when they have unprotected
sex or share needles with someone who has the virus.
The virus
attacks and weakens your
immune system, which is your body's natural defense
against infection. HIV infects certain
white blood cells called
CD4+ cells. If too many of these cells are destroyed
or weakened, your immune system is less able to fight infection and
disease.
HIV infection can lead to
AIDS (acquired immunodeficiency syndrome). People with
AIDS have a low number of CD4+ cells and get infections and some cancers that
rarely occur in healthy people. These can be deadly.
If HIV is
diagnosed before it becomes AIDS, medicines can help keep your immune system
strong and healthy. With treatment, many people with HIV are able to live long
and active lives.
A
combination of three or more antiretroviral medicines, called
highly active antiretroviral therapy (HAART), is the
main treatment for HIV. It can slow the rate at which the virus multiplies,
prevent AIDS, and keep your immune system much healthier than if you used just
one kind of medicine.
The goal of treatment is to reduce the amount
of virus in your body so that it can no longer be found in your blood.
There are several medicines that are most often combined to treat HIV.
They are sorted into five groups:
Protease inhibitors (PIs), such as
atazanavir, saquinavir, ritonavir, indinavir, nelfinavir, fosamprenavir,
lopinavir/ritonavir, tipranavir, and darunavir
You can now get some of these medicines combined into one
pill. So you may only have to take one or two pills a day.
Experts
recommend starting treatment if you have low levels of
CD4+ cells (lower than 350), are pregnant, or you have
or are at risk for other health problems. Medicines can help stabilize and
increase the number of CD4+ cells in your body. And they can prevent
AIDS.
HAART doesn't
cure HIV. But people who take these medicines as prescribed:
Avoid getting
AIDS, or recover from the symptoms of AIDS and enjoy a
return to better health.
Have fewer infections that are common in people whose immune
systems are weak, such as
pneumonia and certain types of cancers. These are
called
opportunistic infections.
See a major drop in the amount of virus in their body, often to
a level where it can no longer be found in their blood.
Have a
stable or slowly increasing CD4+ cell count.
For the medicine to work, you need to take it every day.
If you can't take your medicine as prescribed and you miss doses, HIV may
become
resistant to the medicine and harder to treat.
Antiretroviral medicines can have serious side effects. Some people stop
taking their medicines because they feel too sick to take them. But it's
important that you continue to take them, because these medicines can help keep
the virus under control and keep your immune system healthy.
If you
can't take your medicine as prescribed and you miss doses, HIV may become
resistant to the medicine and harder to treat.
Some side effects, such as nausea, may improve when your body adjusts to
the medicines. If you have problems taking your medicines, talk with your
doctor. There are medicines you can take to treat the side effects.
Side effects of some antiretroviral medicines may include:
Nausea and
vomiting.
Diarrhea.
Fever.
Fatigue.
Headache.
Dizziness.
Belly
pain.
Trouble sleeping.
Certain antiretroviral medicines may also cause more
serious medical problems, such as a buildup of acid in your blood, and changes
in the way your body stores fat and uses sugar.
Personal stories about starting antiretroviral medicine
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
" My cell
counts and viral load are still better than the ranges where most doctors would
offer me treatment. I'm still worried about taking medicine every day, but
these medicines sound like my best hope of living so I can see my daughter grow
up and get married. "
— Marla, age 30
" I put off
taking medicine for HIV for as long as I could, but when my CD4+ cell count
dropped to 350, I decided that it was time to start. The medicines made me feel
dizzy and sick at the beginning, but they are helping my immune system get
stronger. I am feeling a little better every week. "
— Ted, age 45
"I know
several people who were feeling just fine but started HAART and got really
sick. Right now, even though my cell counts are getting close to the
"treatment" ranges, I'm not ready to start taking medicines. I haven't ruled
out taking them later on, but for now I'm going to do the best I can to stay
healthy and appreciate every day that I'm not sick. "
— Greg, age 38
"The past few
years have been a really exciting time for people with HIV infection. I've
followed the research pretty closely, and it sounds like every few months we
know a little bit more about how best to fight this disease. I know that the
newer medicines have fewer side effects than the older medicines, and people
are getting treated earlier and earlier. I'm hoping that the medicines will get
even better by the time my numbers get into the recommended treatment range. In
the meantime, I'm going to take very good care of myself, eat well, exercise,
and try to avoid infections. "
— Miguel, age 40
3. Your Feelings
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take antiretroviral medicines
Reasons not to take antiretroviral medicines
I want to do everything I can to avoid getting AIDS and to live a long and healthy life.
I don't want to start taking medicine until I have to.
More important
Equally important
More important
I'm worried that I might spread HIV to others if I don't treat the infection.
I'm not worried about spreading HIV to others.
More important
Equally important
More important
I'm not worried about the side effects of treatment.
I don't think I could handle the side effects of treatment.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Your Decision
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking antiretroviral medicines
NOT taking antiretroviral medicines
Leaning toward
Undecided
Leaning toward
5. Quiz Yourself
Check the facts
1.
Even though I don't have symptoms of HIV, I may still need to take medicine.
True
False
I'm not sure
That's right. Experts recommend starting treatment if you have low levels of CD4+ cells, are pregnant, or you have or are at risk for other health problems.
2.
Antiretroviral medicines can help me stay healthy and prevent AIDS.
True
False
I'm not sure
That's right. When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.
3.
For the medicine to work, I need to take medicine every day.
True
False
I'm not sure
That's right. You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.
3.
Use the following space to list questions, concerns, and next steps.
Credits and references
Credits
Author
Maria G. Essig, MS, ELS
Editor
Susan Van Houten, RN, BSN, MBA
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer
Peter Shalit, MD, PhD - Internal Medicine
References
Citations
U.S. Department of Health and Human Services (2008). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Hammer, Scott M, et al. (2008). Antiretroviral
treatment of adult HIV infection: 2008 recommendations of the International
AIDS Society USA Panel. JAMA, 300 (5):
555–570.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
U.S. Department of Health and Human Services (2008). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Hammer, Scott M, et al. (2008). Antiretroviral
treatment of adult HIV infection: 2008 recommendations of the International
AIDS Society USA Panel. JAMA, 300 (5):
555–570.
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