If you are living with HIV, you will need to consider treatment options at some point. You have an increasing number of choices regarding how to approach therapies to fight HIV and enhance your immune system.
Registering with an HIV specialist
There are an increasing number 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.
You can access a number of services and specially trained health professionals working at PLHIV (People Living with HIV) organisations throughout New Zealand.
Depending on a number of different considerations, your doctor will recommend a course of treatment. Medication, known as antiretroviral treatment, works to stop or reverse any damage to your immune system, control symptoms and improve your quality of life.
Doctors will 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 against HIV.
Nucleoside reverse transcriptase inhibitors, and Nucleotide reverse transcriptase inhibitors, also known as ‘nukes’. The HIV virus uses enzymes to make copies of itself in your body, NRTIs work to stop the replication of the virus.
Non-nucleoside reverse transcriptase inhibitors, or ‘non-nukes’. These work by binding with the same enzyme to block it through a different mechanism.
These work by stopping HIV locking on to immune system receptors called CCR5.
HIV uses the protease enzymes to break up big protein chains known as poly proteins, which are then used to assemble new viral particles. Protease inhibitors are drugs that block the activity of the protease enzyme.
These are rarely, if ever used, currently. They block the virus from entering the target cells.
These stop HIV from integrating into the DNA of the cells it infects.
Fixed-dose combinations allow you to take fewer pills. The fixed dose is a combination of two or more drugs in a single tablet. This line of treatment is 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 so the levels of certain drugs can be altered to suit your health needs.
Evidence shows there are significant health benefits to starting HIV treatment as soon as possible. Starting early also means your viral load may become undetectable sooner - once this happens, HIV is no longer transmitted sexually (see the section on undetectable = untransmittable). In New Zealand, people can access publicly funded treatment as early as they wish to.
Adherence to medication
Starting treatment for HIV is a long-term commitment. Though being on daily medication may feel like a constant reminder of your HIV status, it is 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 it. This means being consistent with medicines and not missing any pills
You may have to take a number of pills, and needing to take them at strict times may affect your lifestyle, but this is something people get used to over time. Living with HIV does mean an adjustment, but medicines are just a part of life post-diagnosis. Your attitude towards medicines will determine your long-term health, and your body’s ability to cope with HIV.
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 we now know means HIV cannot be transmitted sexually.
Any drug can cause side, or unwanted, effects. These can be divided into different types:
- Allergic reactions and short-term side effects
- Ongoing side effects
- Long-term toxicities or effects that can develop over a number of years
Not everyone gets side effects from their drugs and not everyone experiences the same side effects; many are quite rare. It’s hard to know how often people develop different side effects as estimates and studies show varying figures.
Most HIV treatments are known to cause diarrhoea, headaches and gastrointestinal upset to some degree, but these side effects are often easily managed and, in most cases, reduce over time. If you start treatment with a low CD4 count or high viral load, side effects may be more of an issue and you may need help pre-planning for effective management.
Wherever a drug has been shown to potentially cause adverse reactions, it will be accompanied by a warning. Your doctor will also advise you about it and what to do if something like a hypersensitivity rash occurs.
Direct reactions to the drugs can cause a range of, sometimes, ongoing side effects, which can vary from mild, like headaches or occasional diarrhoea, to more serious, such as a slow decline in kidney function. There are also some problems, which may develop over time, like numbing of the fingers and toes, abnormalities in liver function or abnormal redistribution of fat throughout your body. Most of these problems tend to happen with the older drugs, however. With the newer drugs, there are far fewer side effects to worry about.
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 are usually a rash or fever. Often, these symptoms will resolve themselves, but if you develop a rash when beginning a drug, seek medical advice – on rare occasions some allergic reactions can be dangerous. Your doctor may be able to treat the rash with antihistamines or by slowly increasing your dose as your body gets used to the drug.