HIV Treatment Basics
HIV Treatment Basics
Charles Farthing (Chief of Medicine, AIDS Healthcare Foundation) gives expert video advice on: How is HIV treated?; If I live in a small town, where can I find HIV treatment?; Is it safe to buy HIV medication sold without a prescription? and more...
How is HIV treated?
HIV is treated in adults and adolescents, and children, with a combination therapy of three or more (usually three) antiretroviral drugs given together.
If I live in a small town, where can I find HIV treatment?
In remote areas, even in the United States, it is often difficult to treat HIV. However this is particularly true in resource-limited settings and in rural Africa, for example. When that situation exists, I guess the patient has to be very proactive to try and find an HIV specialized provider for their HIV treatment. In the United States, there are various ways that a patient can do that, for example, the American Academy of HIV Medicine has a website, www.aahivm.org; anybody can go to that web site and click on 'Find a provider" and put in their address, their city, or their zip code and find doctors in the area who are credentialed HIV specialists or who belong to that organization. That way, in terms of your HIV treatment, you can at least find a doctor who is interested in HIV and knows about it.
When can I begin treatment for HIV?
Treatment for HIV is usually begun when the immune system is showing signs, by CD4 testing, of being impaired to a possibly dangerous degree, which we now consider 350 CD4 cells per cubic millimetre of blood. So when the CD4 hits 350 in an HIV patient, the doctor generally recommends starting antiretroviral therapy.
Is it ever necessary to start treatment if my CD4 count is higher than 350?
There are many times when we might want to begin antiretroviral therapy at a CD4 count higher than 35. For example, if someone has skin rashes associated with HIV, if they have Kaposi sarcoma or lymphoma. There are a number of rare conditions that they might get associated with HIV, that you might want to start the treatment sooner.
How many pills do I have to take during my HIV treatment?
The number of pills you have to take during your HIV treatment depends a lot on when you started being treated. If you started being treated for HIV 15 years ago, because of the weakness of the original pills and the way we prescribed them initially, you've probably become resistant to multiple HIV drugs already. And so you probably will have to take at least three or four pills once a day to control your HIV, and you may have to take four or five pills twice a day to control your HIV. But for someone who's become infected with HIV now and just starting treatment, the majority of HIV patients begin these days with one pill once a day, or at the most, three pills once a day.
Why would my HIV medication need to be changed?
Your HIV medication would need to be changed for either one of two reasons.Either the drugs are upsetting you, which might be something you feel or might besomething the doctor would noticed with his monitoring blood tests, so that could be a reason for changing the therapy. The other reason is that it's no longer working and the HIV viral load testing tells us that. If the virus isn't undetectable and you're taking the drugs and it's not working, then you need to change. Generally, HIV medication will not stop working if you take it very regularly, but if you are one of the patients that misses doses, it may well stop working and you may need a change a therapy. Nowadays we have some 20 medications, so there is a second or third and often a fourth if patients break through and get resistant to their drugs, but it doesn't go on forever.
Can my HIV medication bring my viral load down?
Your HIV medication should bring your viral load down, and should bring it down very quickly. In fact, it should bring your viral load down to undetectable in between one and four months. The reason there's a range there is that if it's a relatively low viral load, it will probably come to undetectable within a month. If it's a high viral load, it may take four months, or even slightly longer.
How long can I expect to live if I take HIV medication?
I think people with HIV infection now should lead a normal lifespan. If their lifespan is going to be shortened by the disease, it should be only by a very few years. The disease can be shut down. It becomes a chronic viral infection with the use of antiretroviral therapy. It's inactive and we in our body have many chronic viral infections. If we've ever had chicken pox, live chicken pox virus is still in our body but it is kept inactive for the rest of our lives by the action of our immune system. Our immune system is not good at fighting HIV because it is new to the species. You have to shut it down another way. The HIV medications shut down the HIV infection just as well as the immune system shuts down chicken pox. As long as we keep our HIV disease shut down with the antiretroviral medicines, we should lead a normal life.
Are alternative treatments effective in battling HIV?
Many patients ask about alternative treatments for HIV. I think alternative treatments can help patients a lot in general ways, but they seldom are specific for HIV and seldom help HIV directly. None of the alternative medicines have been found to affect HIV viral load for example in any significant way or to decrease HIV death rate. However, alternative therapies can be helpful to HIV-positive patients in many ways. HIV patients often suffer stress from the HIV positive diagnosis and alternative therapies are often better than medical therapies in treating stress. Acupuncture, yoga, meditation, therapies like that, the therapist often spends a lot longer with the patient and they manage stress far better than conventional medicine. Drugs like valium, which the patient can get habituated to, may actually cause problems down the line in an HIV sufferer. So I am a great believer in using complimentary medicines to help my HIV patients, but not as an alternative to antiretroviral therapy. There is no alternative to that for HIV patients.
Is it safe to buy HIV medication sold without a prescription?
It would be very unwise to self-medicate with any retro-viral medications or to buy medications for HIV and not get them from a doctor, because they have to be taken at the right concentrations, in the right combinations, at the right intervals. If that's got wrong, then it's very likely the virus will become resistant to that regimen. That's a very serious thing, because there's a lot of cross-resistance between different antiretrovirals, and you will have done yourself potentially a lot of damage by getting resistant. There's a problem in many resource-limited countries where doctors who have no HIV experience sometimes prescribe drugs in very inappropriate ways, but that doesn't tend to happen very much in this country.
How much does HIV medication cost?
HIV medication in this country costs about $15,000 a year. It's about $500 per drug per month. It's quite expensive, but mostly the cost of the HIV medication is born by the government or by private insurance. There are very few patients that ever have to pay for HIV medication. If the patient doesn't have private insurance, and doesn't have government insurance such as Medicaid, then there is a program called the AIDS Drug Assistance Program which is funded federally, by the Ryan White Care Act, and also usually augmented by state funds. It provides all anti-retroviral medication free for all Americans and all illegal immigrants as well. Anybody who is living in the United States can access anti-retroviral therapy if they can't afford it and don't have insurance.