HIV Treatment (Antiretrovirals)

Medications for HIV are called Anti-Retrovirals (ARVs), because HIV belongs to a family of viruses called Retroviruses.ย  Antiretroviral Treatment is called ART (used to be called “Highly Active ART” or “HAART,” but nobody says that anymore).ย  ART stops HIV from multiplying, but doesn’t cure it, because HIV can remain latent or dormant (“asleep”) in the body, ready to multiply rapidly if medications are stopped. For a discussion of what a virus is, see Germs: Differences Among Them.

ART is life-saving.ย  Before 1996, when the first effective treatment was available, virtually 100% of people with HIV got AIDS and died.ย  Now, nobody who takes their medications correctly will even get sick.ย  It’s thought that a person with HIV who sticks with treatment should live a practically normal life span.ย  We can monitor the success of treatment by a test called the Viral Load, which counts HIV particles in the blood.ย  If the result is โ€œundetectable,โ€ meaning the test canโ€™t find any virus, we know the ART is working perfectly.

We urge people with HIV to begin treatment as soon as possible.  We used to wait, until their blood tests suggested the disease was advancing.  But now we realize that even if AIDS doesn’t seem a close risk, it’s simply bad to have HIV multiplying in the blood.  The body’s reaction isn’t good for the heart or kidneys, and might make it easier to get cancer.  Untreated HIV may be as bad for the heart as smoking cigarettes is.

Treatment also helps prevent HIV transmission.  If the virus can’t multiply, there are very few in blood and body fluids.  So if the Viral Load test result is โ€œundetectable,โ€ a patient wonโ€™t be able to pass the virus.  A pregnant woman with HIV who takes medications correctly has almost no chance of passing the virus to her baby; we encourage HIV-positive couples who want children to learn the safest way to proceed, and not be afraid.

There are lots of medications available, all work well.ย  Most can be taken one time a day.ย  Everyone has to take several different medicines, but they can often be combined together into a single pill.ย  Some are more or less appropriate for certain people depending on blood tests.ย  Some can’t be taken with certain other medications.ย  Side effects are very few with today’s meds, nothing like the ones we saw 20 years ago.ย  Nobody should be scared by what they read about side effects — click for a discussion of why Lists of Side Effects May Be Very Misleading.

The main problem with ARV medications is that if they’re not taken correctly, HIV can become resistant to them.  Then treatment doesn’t work anymore, and we have to substitute other drugs that may be less convenient to take.  If a person takes ARV medications properly every day, there will be enough in the blood to prevent virus from reproducing.  If they don’t take ARVs at all, virus will reproduce, but there will be nothing around to become resistant to.  Resistance only occurs when there is some medication in the body, but not enough.

A common mistake I see patients make is when they adhere perfectly to a schedule, then come home 6 hours late.ย  Taking doses late and erratically isn’t good, but missing doses is much worse.ย  If a patient takes their meds once a day, even if they wind up 15-18 hours late, I tell them to take the dose, & then continue with the next dose right on schedule.ย  If this happens every few months, it would be highly unlikely to generate drug resistance.

The worst mistake I saw a patient make was someone who traveled to Mexico, then had to stay an extra month due to family emergency.  In order to make his supply last, he took his medications every other day; when he returned, his HIV strain was resistant to all of them!  It would have been much better taking them daily on schedule, running out, then starting up again when back home.  [Note — there’s 1 type of drug that has to be treated differently; discuss with your provider as necessary].

I find that the hardest thing for many of my patients is being sure not to miss doses.  As such, they must carry a dose or two in case they’re out for the night, can’t take long vacations, have to watch out for insurance changes & pharmacy holidays, and the like.  It’s the only condition I know of that if you miss doses too often, the medications no longer work.  But many patients have been taking HIV medications for 20 years or more without problems.  If they’re committed to treatment, HIV is much easier to treat than many other diseases like diabetes, hypertension, etc.

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