You and your doctor should consider several factors in deciding when to start drug therapy. Your viral load and CD4 (T-cell) count will help determine whether you should start treatment. You also should consider how well you will be able to follow your treatment and weigh the potential benefits and risks.
No. This does not mean that you are cured of HIV. This means that the virus in your blood is so low that the test used to measure the viral load could not detect it. You are still infected with HIV and should continue to practice risk-free behaviors. Someone with an undetectable viral load is still able to transmit HIV to another person. You will need to continue to see your doctor on a regular basis.
Viral load is the amount of HIV in a person’s blood. People with high viral loads are more likely to rapidly progress to AIDS than people with low levels of the virus.
A CD4 (T-cell) count is a measurement of a person’s CD4 T-cells. HIV infects a person’s CD4 (T-cells) and uses these cells to replicate (make copies of itself). As these cells are destroyed, the person’s immune system is weakened, and the person is more likely to develop an opportunistic infection.
My doctor and I have decided not to treat my HIV infection. Do I need to have my CD4 T-cell count tested again?
Yes. HIV-infected persons who have not started drug therapy should have a viral load test every 3-4 months and a CD4 (T-cell) count every 3-6 months. Talk to your doctor about when you should be tested again.
In general, your viral load is the most important factor in determining whether your medications are working. Other important factors are your CD4 (T-cell) count, your recent clinical history, and findings from a physical examination by your doctor. Your viral load should be tested again 2-4 weeks after you start treatment. If your drugs are working, your viral load should be decreasing, and it should continue to decrease as you continue to take your medications.
Throughout HIV treatment, your viral load should be tested every 3-4 months to make sure your drugs are still working. If your viral load is not detectable within 4-6 months after starting treatment, you should talk to your doctor about possibly changing your medications.
How fast or how much your viral load decreases may depend on other factors, not only on the drugs you are taking. These factors can include your baseline viral load and CD4 (T-cell) count (before starting therapy), whether you have used Antiretroviral drugs before, whether you have any AIDS-related illnesses, and how closely you have followed your therapy. Talk to your doctor if you are concerned about your viral load not decreasing. CD4 (T-cell) counts also may help show how well your medications are working. After starting drug therapy, your CD4 (T-cell) count should be tested every 3-6 months. Talk to your doctor if you are concerned about your CD4 (T-cell) count.
Tell your doctor if you are having any problems related to your medication, including side effects. If you are experiencing side effects, tell your doctor what they are, and when you notice them. Your doctor needs this information to help you maximize the benefit from your treatment plan and provide workable options, if necessary.
Skipped doses: Do not be afraid to admit to skipped doses. Your doctor knows that some people do have difficulty taking each dose as prescribed. If you have skipped doses, tell your doctor which medication(s) you skipped, and when.
Difficulty taking your medication as prescribed: If you are supposed to take medication on an empty stomach or with food, and this is difficult for you, tell your doctor. If there is a time of day that is too difficult for you to take your dose, tell your doctor this, too.
Your treatment regimen interferes with your lifestyle: If you feel your treatment regimen is too complicated or unrealistic for you to follow, talk to your doctor about other options you may have.
HIV treatment is the use of Antiretroviral drugs to decrease a patient’s viral load. In most people who start HIV treatment (Antiretroviral therapy), the viral load drops to undetectable levels (below 500 copies/ml) within 12-16 weeks. However, Antiretroviral therapy is complex, and different people may have different results. Antiretroviral therapy has been shown to benefit HIV-infected persons with advanced HIV disease and weakened immune system. Many experts believe that treatment will also benefit people with earlier stages of HIV disease.
Yes. Adherence is a major issue in HIV treatment, for two reasons. First, adherence is important for treatment effectiveness (how well the medications work to decrease the viral load). When you skip medication doses, the virus has the opportunity to replicate (make copies of itself) more rapidly thereby making it difficult for the drugs to be effective. Other factors that may affect treatment effectiveness include your baseline viral load and CD4 (T-cell) count (before starting therapy), whether you have any AIDS-related illnesses, and whether you have used antiretroviral drugs before.
Second, adherence to HIV treatment is critical to prevent drug resistance. Clinical studies have shown that when you skip medication doses, or take a “drug holiday”, you may develop strains of HIV that are drug resistant. This may leave you with fewer treatment options if your viral load does not decline. Because drug-resistant strains can be transmitted to others, drug resistance has serious consequences not only for you but for the larger population as well.
There are two possible reasons for this. One possible reason is drug intolerance (side effects which make it difficult to take the drugs as prescribed). Another possible reason is drug failure (your viral load is not decreasing). You should ask your doctor to explain why the change is needed in your treatment.
If the reason is drug intolerance, your doctor may change the drug(s) causing the problem. In this case, your doctor may substitute drugs with different ones of the same potency and class.
If the reason for changing your medications is drug failure, your doctor should change all your drugs to new ones you have never taken, if possible. If you have been taking three drugs, and all three drugs cannot be changed, then at least two drugs should be changed. This is very important to reduce the risk of developing drug resistance.
Before changing your medications, you should talk to your doctor about:
- All the antiretroviral medications you have taken before
- The potency of the new drugs your doctor recommends
- Possible side effects of the new drugs
- How well you will be able to follow the new treatment
- The number of antiretroviral drugs remaining that you have not yet used
If you have no treatment options for approved drugs, you may be able to participate in a clinical trial using drugs that are being studied. For more information ask your doctor, or call the AIDS Clinical Trials Information Service (ACTIS) at 1-800-874-2572 or connect to the ACTIS web site at www.actis.org.