Things to Consider

The things that you and your health care team need to consider should act as an ongoing framework for your HIV treatment. If your first treatment combination doesn't work or if you need to change, the same issues will need to be addressed, so plan for the future now to be prepared. For most people, a doctor or health care team will explain what your options are, and why. Other people will want to be a very active partner in researching and making treatment decisions. It's up to you.

If you chose to let your doctor deal with these decisions, you must follow his or her exact instructions. Your job will be to let them know everything that is going on, from small issues that bother you to big changes in your body. If it feels not right, let someone know. Keep an open line of communication. If that is a problem, it needs to be addressed. A case manager, or a counselor or a trusted friend could be a big help.

Here is a brief list of the issues that you need to address related to HIV treatment. Some people will need to look at each one carefully. Other people will be precribed a combination of meds and get on with their lives with no big complications - there are once or twice a day pills that work quite well for people who can access them. Then again, the same people might not start having issues until they have been on treatment for months. Comparing your progress with others may be interesting, but the most important thing to be concerned about is you and the following issues:

• If you are recently infected or if you have symptoms of HIV disease (symptomatic) or if you have 350 or fewer CD4 cells - also referred to as T4 or T cells - you should seriously consider starting HIV treatment as soon as possible, especially if you are losing CD4 cells quickly or have a high HIV viral load ( measured by an HIV PCR test).


• Get a Drug Resistance test done along with other blood work, including tests for hepatitis. The resistance test lets you know what drugs will work best for you. It's not uncommon for a doctor to prescribe a combination of drugs for you to take while you are waiting for the results of these tests. Then he or she may instruct you that you only need to take some of those drugs. Otherwise, they will wait for the results of the CD4 panel, the heptitis panel, the CBC, and resistance tests to come back first. Special tests are strongly recommended before starting any drug combination with Ziagen (abacavir) or Ziagen itself, as well as maraviroc (Selzentry). There are also other approved HIV treatments that can have some serious side effects that you want to avoid if you have other options. Some drugs should never be taken if you are pregnant or plan to become pregnant.


• Carefully choosing the right first treatment combination is extremely important. Once you start you must be committed to keep taking that regimen exactly as it has been prescribed unless it causes severe side effects. Do not reduce your number of pills or take them less than you should without having a serious discussion with your doctor. Your doctor and you should work something out together if you are having any problem (even money issues) before you change anything or make any decisions. If your first treatment regimen can't be tolerated or just doesn't work, what is your second option? Make sure to have your second treatment regimen thought out, just in case. Odds are that you won't need it if you are serious about reducing your viral load to undetectable. That is the goal of HIV treatment. If you get on the right first regimen and stick to it, it could effect your treatment for your entire life - which could be very long. Please don't invite additional problems by having unsafe sex or injecting drugs, especially if you have a detectable HIV viral load. And catching other diseases when you have HIV is not something you'll ever say was worth whatever you were doing that was unsafe. Get counseling. Care about other people because they do care about you.


• Are you sexually active? If you do not have hepatitis A or B, get vaccinated. There are also other vaccinations you should get as well. Treat any sexually transmitted diseases (STD), and don't have unsafe sex. Just because you have HIV doesn't mean that you won't get infected with sexually transmitted diseases. You could also give someone HIV along with an STD. Are you using birth control or condoms to prevent a pregnancy? Some drugs can actually harm an unborn fetus.


• What other drugs are you taking for other conditions? If, for example, you have to take medications for your heart or kidneys, will adding an HIV treatment regimen affect the amounts of any of the drugs you take now or just started?
  
  
  • Do you have diabetes?
  • How about chronic hepatitis B or C ?
  • Do you have high blood fats or liver problems?
  • Are your heart and kidneys in good shape?
  
  Depending on the answers to these questions, you may have to take a specific HIV treatment regimen for your condition.


• Are you ready to start treatment?
  • Are you willing to commit to taking your medications as they are prescribed to prevent resistance from developing?
  • Is your schedule set up so that you can take your meds at the same time every day or does that need to be worked out?
  • Is your treatment combination - maybe one pill once a day at this point - convenient for you or do you need help remebering to take all your meds?
  • Based on the common or expected side effects of a treatment combination, would it be better for you to take a different treatment regimen that required two pills twice a day?
  • Will the side effects of the treatment regimen you choose to take go away in a week or two, or remain constant?
  • Are there any side effects or conditions that you are unable to deal with or unwilling to accept?
  • Are you aware of the consequences of stopping your chosen treatment regimen once you start?


• HIV treatment means finding a team of providers who can offer health care services, case management, supportive or mental health counseling, or assistance with things like food, housing, employment, legal issues, alcohol or substance use, or getting the medications you need. All of these issues could and often do affect the success of HIV treatment. Do you need help setting this up? The Network and other community organizations and agencies offer assistance in a confidential manner. Maybe this should be the first thing you do before going any further with HIV treatment.

What you Should Avoid

Peripheral neuropathy usually shows up as sharp burning pain sensations in the hands and/or legs. Early signs are a burning sensation or a numbness, like a deep pain that may come and go but always affects the same spot. Early symptoms of peripheral neuropathy are a tingling sensation in the fingertips, feet or legs. This side effect can sometimes be eliminated by using a lower dose, but then it would be better just to discuss the situation and resolve it properly with your doctor or health care team

Peripheral neuropathy is much more common with the use of Zerit and Retrovir. Other rare but potential potential side effects of these and other drugs are pancreatitis, elevated liver function tests and bone marrow suppression<. Symptoms of pancreatitis can be pains in the stomach area that go through to your back, and you should notify your doctor immediately if these symptoms occur. Your bloodwork should also be routinely checked for any signs of pancreatitis. Liver function should be closely monitored if you are taking Zerit. Bone marrow suppression is monitored through your blood work. Bone marrow suppression does not occur as frequently with Zerit as with Retrovir.