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Starting Anti-HIV Therapy

	Deciding when to start anti-HIV therapy and what treatments to start with can leave many people feeling overwhelmed with choices. The choices may be fewer and simpler than they appear at first. Charting your course of therapy options up front, outlining what therapies you will start with when you're ready and what you will switch to if that option doesn't work out, is the hallmark of long-term planning. You can then proceed to the next combination with confidence rather than being overwhelmed by the fact that your first choice didn't work out as you had expected.

Most strategic decision-making processes begin by formulating a list of questions to consider. Some of the answers can only come from you; others your doctor can help answer. Several important questions about starting anti-HIV therapy are included here.

Questions to Help You Build Your HIV Treatment Strategy ++ What is your current CD4+ cell count? ++ What is your current viral load? ++ How is your general health? ++ Are you ready and willing to commit to using therapy? ++ Are you aware of how therapy may impact your quality of life? ++ Are you aware of the potential side effects of the therapies? ++ Do you know which therapies may preserve more options for later?

The question of what combination of anti-HIV drugs a person should use as first-line therapy can appear confusing at first. There are, however, only a few factors to consider and these effectively narrow the range of choices for first-line therapy. These include: the potency of the combination, the ease of use and number of pills, and the potential for short and long-term side effects. If you have determined that you are ready to start anti-HIV therapy, there are some clear guidelines that can help you make an informed decision about which medications to use.

Remember the Goals of Anti-HIV Therapy: An effective combination should lower your viral load as low as possible (preferably to undetectable), and increase your CD4+ cell count, without causing debilitating side effects or negatively affecting your quality of life. It should also be easy enough to take, given your schedule, that you are able to take every dose as prescribed (i.e., adhere well). The issue of adherence to medications cannot be stressed enough.

The Basic Message: Learn about HIV testing options and choose one that fits your needs! Be sure your privacy is protected! If you're positive, don't panic. If you make your health a priority, chances are you will be reasonably healthy for many years. Learn about your healthcare options and local support services. Get a complete physical and blood tests for CD4+ cell count and HIV level. Repeat quarterly and watch for trends. Work with a doctor to develop a long-term strategy for managing HIV disease. If the CD4+ cell count is below 350 or falling rapidly, consider starting anti-HIV therapy. Test at least twice before taking action. If anti-HIV therapy fails to reduce your HIV level below the "limit of detection" or below 5,000 copies within 3–6 months, consider a different or more aggressive therapy. If the CD4+ count trend stays below 300, consider treatment for preventing PCP. If it stays below 200, start treatment for preventing PCP (if you haven't already done so) and reconsider anti-HIV therapy if not on one. Learn about drug interactions and preventive treatments for opportunistic infections. If you started preventive therapies and your CD4+ cell count rises in response to anti-HIV therapy, ask your doctor whether it might be safe to stop certain preventive therapies. If your CD4+ cell count stays below 75, consider more frequent blood work—perhaps monthly. Consider therapies for preventing MAC/MAI and CMV. Regularly seek support for your personal, spiritual and emotional needs. It takes more than medicines to keep you well.

(Please reread our other health stories in our archived list for additional HIV/AIDS information.)