Monitoring your health

Having a good relationship with your General Practitioner is the first step in managing your health.

Relationship with your doctor

A trusting relationship with your GP or HIV specialist is a key part of maintaining wellness. If you don’t feel comfortable, first talk to them and, if that doesn’t change things, find someone else. The more comfortable you feel to share all aspects of your lifestyle with your doctor, the better they can help you.

There are some simple things you can do that can make doctors appointments easier. Beforehand, make a list of questions you want to ask so you won’t forget. Remember, you can always take a support person with you. Take a pen and paper to make notes of everything the doctor tells you. This helps you to have the information handy when you want to think through your options later. Ask the doctor how many times you will need to meet them and make your next appointment.

If you’re living with HIV and seeing a doctor for a non-HIV related condition, it is a good idea to disclose your status to them – and to tell them what antiretrovirals you are taking – so they can give you the right medicines and treatment. Anything you say to your doctor is kept confidential. 

Viral load

Viral load is the amount of HIV in your blood. The more HIV in your blood, the higher the viral load. A viral load test shows the number of copies of the HIV genome or DNA detected in a millilitre of your blood. The viral load will affect how quickly your immune system is attacked by HIV and will affect the levels of your CD4 cell count. This will be different from person to person and it also depends on your existing health. If you’re not taking HIV treatment, the level of your viral load can fluctuate between tests. Your doctor will monitor and confirm trends with further tests. 

The goal of HIV treatments is to keep the viral load to a low enough level so that it is not picked up by tests. Staying on your treatment, taking your medication consistently and looking after your health will result in decreasing levels of the virus in the blood. 

A few weeks after starting your treatment, viral load tests will give you and your doctor an idea of whether the treatment is working. 

Just because HIV is not being detected in your blood does not mean that it isn’t present in other parts of your body such as sexual or rectal fluids. While treatment can lower viral load in your sexual fluids, a viral load test does not measure this. Your viral load can also fluctuate and can increase significantly if you have an STI such as chlamydia or gonorrhoea. Using condoms is still the best way to effectively protect any sexual partners from HIV and other STIs. 

HIV also infects cells that remain inactive or ‘resting’ in your lymph glands. This infection of resting T-cells and organs (reservoirs) that are hard to reach and treat is the reason why HIV eradication, or a cure, has not been possible so far. 

CD4 count

CD4 cells are a type of white blood cells in the blood. CD4 cells are also sometimes called T4 cells or helper cells and they organise your immune system’s response to infections. 

Measuring CD4 cells is a way to understand how healthy your body’s immune system is and how efficiently it will protect you from secondary infections. The number of these cells in one cubic millilitre of your blood is your CD4 count. 

When you’re first diagnosed with HIV and when you start your treatment, your CD4 count will be watched quite closely by your doctor or HIV specialist. If your CD4 count is below 500, your immune system is starting to feel the burden of HIV. 

It is most likely that your CD4 count will have dropped sharply soon after infection and then become stable. The HIV virus attacks and infects CD4 cells and, even if you have no obvious and visible symptoms of HIV, your body loses CD4 cells every day. Your body will make and attempt to replace them, but your CD4 count will fall over time. 

After you begin treatment and your viral load starts to fall, your CD4 count will increase. The speed at which this occurs is different for everyone. Your overall health will affect the number of times you will need to take the CD4 count test. 

Once your viral load is undetectable and your CD4 cell count has been above 350 for some time, your doctor might stop monitoring the CD4 cell count as any further fluctuations will not alter the treatment. 

Only a small proportion of your body’s CD4 cells are in the blood and much of the CD4 reserves are in other organs like the spleen and lymph nodes. The CD4 count for a person not living with HIV is in the ‘healthy’ range of 500 to 1500. It is good to keep in mind that CD4 counts can vary quite a bit in people and can go up and down depending on various factors, including if you have other infections like the flu or if you’re under stress. 

Exercise and eating

Exercising, watching your diet and ensuring a good intake of vitamins and minerals will help strengthen your immune system.

Regular exercise will improve your wellbeing. Depending on your overall health, your doctor will recommend how much or how little exercise you need. Generally, moderate exercise helps to strengthen the immune system.

HIV can interfere with the way your body uses food and energy. Sometimes you may need to eat more than usual or eat certain types of food in order
to maintain a healthy body weight. You may want to consider working with a nutritionist who has experience with people living with HIV, as a part of your treatment plan.

Some older HIV medications have a side effect called lipodistrophy where you can lose or gain fat in different parts of your body, but these medications are not used very often. 

Alcohol, drugs and cigarettes

Though alcohol doesn’t necessarily interact in any major way with antiretroviral medicines, heavy drinking and any associated damage to your liver may interfere with HIV treatment. Enzymes present in the liver may be necessary for the effective processing of certain drugs, including protease inhibitors.

There’s not a lot known about how HIV treatments interact with illicit
or recreational drugs, though research is being constantly updated. For example, there is an increasing body of evidence about methamphetamines and brain damage in gay and bisexual men living with HIV, leading to early dementia and increased risk-taking behaviour during sex. HIV specialists advise against the abuse of alcohol and illicit drugs when living with HIV. For more information visit alcohol.org.nz and drughelp.org.nz.

If you do use illicit drugs, here are some ways to minimise risk:

  • Avoid taking HIV treatments and other drugs at exactly the same time: wait at least a couple of hours between doses.
  • Some HIV drugs, such as Ritonavir and possibly other protease inhibitors, may cause dangerous, even fatal interactions withecstasy,Pandothertypesof methamphetamines. HIV drugs also slow down the elimination of recreational drugs from your system.
  • Drink plenty of water.
  • Start with a smaller amount of any illicit drug and monitor any unusual responses.
  • Seek emergency medical help if you experience dizziness, sudden drowsiness, blurred vision, heart palpitations, vomiting or any other severe or unexpected effect.
  • Methamphetamines and ecstasy can make eating difficult; which can be a problem for people who need to take treatments with food.

If you smoke cigarettes, cutting back or quitting will improve the effectiveness of treatment and will ease stress on your immune system. Smoking is damaging to everyone’s health, but if you are living with HIV
all the risks of smoking (including but not limited to lung cancer, heart attacks, strokes and abnormal clotting in the legs and lungs) are significantly increased. For support to quit smoking visit quit.org.nz or call Quitline on 0800 778 778