Being diagnosed with HIV in 2020 is far different to what it used to be 30, 20 or even 10 years ago.
HIV is now a treatable, manageable health condition that requires medication taken daily and specialist visits once or twice a year - much like many other chronic conditions. Being diagnosed with HIV today is not a death sentence.
Evidence shows there are significant long-term health benefits to starting HIV treatment as soon as possible after diagnosis. Starting early also means your viral load may become undetectable sooner - once this happens, HIV is no longer transmitted sexually (undetectable = untransmittable). In Aotearoa, you can access publicly funded treatment as early as you wish, regardless of your immigration status.
There are increasing numbers of options available to you for treating HIV. Registering with an HIV specialist is essential in order to find out what options are best for you. This is free through public hospitals and Sexual Health Services. In the meantime, our counsellors are available for guidance and support.
You can access a number of services and specially trained health professionals for People Living with HIV (PLHIV) from organisations throughout Aotearoa.
Depending on a number of considerations, your doctor will recommend a course of treatment. Medication, known as antiretroviral treatment, works to halt the viral replication and stop or reverse damage to your immune system, control symptoms, and improve your quality of life.
Doctors can use a combination of different anti-HIV drugs to stop the virus from replicating and to protect your immune system. There are currently several classes of antiretrovirals and they all work in different ways to control HIV. People usually take two or three medications belonging to at least two different classes, to make sure the virus doesn’t become resist to any individual agent.
NRTI stands for Nucleoside Reverse Transcriptase Inhibitors, or Nucleotide Reverse Transcriptase Inhibitors, also known as ‘nukes’. HIV uses an enzyme called transcriptase to make copies of itself in your body, and NRTIs work to stop this enzyme from allowing the replication of the virus.
NNRTI stands for Non-Nucleoside Reverse Transcriptase Inhibitors, or ‘non-nukes’. These work similarly to nukes, by binding and blocking the enzyme HIV uses to make copies of itself, preventing the cell from producing new virus.
There are two slightly different mechanisms in this class, yet both prevent entry of the virus into the healthy immune cells (CD4 cells). Nowadays, these drugs are not used very often.
CCR5 inhibitors work by stopping HIV locking on to immune system receptors called CCR5. The fusion inhibitors work through binding to gp41 proteins on the cell surface, stopping the virus from ‘fusing’ with its targets.
HIV uses the protease enzymes to break up big protein chains known as poly proteins, which are then used to assemble new viral particles and produce new virus. Protease inhibitors are drugs that block the activity of the protease enzyme.
Integrase inhibitors stop HIV from integrating into the DNA of the cells it infects, through blocking an enzyme called ‘integrase’.
Fixed-dose combinations or single tablet regimens
Fixed-dose combinations allow you to take fewer pills. The fixed dose is a combination of two or more drugs into a single tablet. This line of treatment can be advised depending on your existing health and whether you’re already living with other health conditions. In some cases, being on separate pills is a better option, as the levels of certain drugs can then be altered to suit your health needs. Single tablet regimens (STRs) allow PLHIV to take only one pill per day, because they contain all the necessary ingredients in it.
Starting treatment for HIV is a long-term commitment and, although, being on daily medication may feel like a constant reminder of your HIV status - it’s important to stay on track with treatment. This is because if you stop taking medication, or take it irregularly, the virus may become resistant to those drugs. This means you need to be consistent with taking medicines and not miss any appointments.
You may have to take a number of pills, and needing to take them at specific times may affect your lifestyle, but this is something most people living with HIV get used to over time. Living with HIV does mean an adjustment, but medicines are just a part of life post-diagnosis. Your practices surrounding medicine will determine your long-term health, and your body’s ability to cope with HIV.
If you think your current treatment is too complicated for you to manage, make sure you approach your doctor about it – it may be possible to switch to something easier. It is never a good idea to stop antiretroviral treatment.
Downloading an app like Care4Today can help you stay on track with your medication and appointments.
Not only is adhering to your prescribed medications the best way to ensure you live a long and healthy life, but it can result in achieving an undetectable viral load, which means you cannot sexually transmit HIV.
Any drug can cause side effects. Not everyone gets side effects from their drugs and not everyone experiences the same side effects. In fact, many are quite rare.
Direct reactions to the drugs can cause a range of, sometimes ongoing, side effects, which can vary from mild to more serious:
- Occasional diarrhoea
- Slow decline in kidney function
- Numbing of the fingers and toes
- Abnormalities in liver function
- Abnormal redistribution of fat throughout your body (this is very rare nowadays)
However, most of these problems tend to happen with the older drugs, and more serious effects would likely develop over a period of time. With the newer drugs, there are far fewer side effects to worry about. In fact, many people report not experiencing any adverse effects at all!
You can ask your doctor about side effects and how best to manage them.
Allergic reactions to a drug are unpredictable – a few people may suffer them, but the majority won’t. Allergic reactions can occur when the immune system reacts badly to a drug and the symptoms may include a rash or fever. Often, these symptoms will resolve themselves, but if you develop a rash or experience any (even minor) difficulty breathing when beginning a drug, seek medical advice – on rare occasions some allergic reactions can be dangerous.