1. When should HIV treatment start?
It is recommended that everyone living with HIV be on HIV treatment, and as soon as possible after diagnosis. So, say the HIV treatment guidelines from the U.S. Department of Health and Human Services (DHHS).
2. What does HIV treatment do?
The goal of therapy is to suppress the amount of virus (called “viral load”) to an undetectable level (meaning the virus in your blood is so low, it cannot be detected by normal tests). This will keep you healthy, and the sooner you start therapy, the less damage to your immune system so you’ll stay healthier, longer. It also means you can’t transmit HIV to your partner when you are on antiretroviral treatment (ART) and undetectable at less than 200 copies for at least six months (undetectable equal untransmittable, or U=U; also called “treatment as prevention,” or TasP). HIV treatment should also raise the number of your CD4+ T cells, a measure of the immune system.
3. What tests are needed before taking HIV therapy?
You will be tested for STIs, hepatitis B and C virus, and HIV drug resistance. With the “Rapid Start” strategy recommended by DHHS, you will begin treatment while awaiting test results. Not all HIV meds are recommended for Rapid Start.
4. Is HIV treatment a cure?
Treatment does not cure HIV, but maintains health and prevents transmission.
5. What does HIV treatment consist of?
HIV therapy consists of medications from at least two drug classes. HIV drugs are called “antiretrovirals” (ARVs). To quickly find your drug, go to “Getting Around” in this issue. A single-tablet regimen (STR) consists of two or more ARVs which represent at least two drug classes and form a complete HIV treatment in one pill taken once daily. STRs are widely used by people taking HIV treatment for the first time (called “treatment naïve”), but they are not for everybody, including some people who are treatment-experienced or have multi-drug resistance. A fixed-dose combination (FDC) also combines two or more ARVs in one pill, but most consist of the same drug class and must be taken with at least one other HIV medication. An STR is a type of fixed-dose combination. This year sees the introduction of a long-acting injectable regimen (Cabenuva), which consists of two intramuscular injections taken every four weeks. See how the drugs work on page 18.
6. How should HIV treatment be taken?
Getting to and staying undetectable requires adherence: taking your medication as prescribed (for example, with or without food) and not missing doses. Discuss any concerns with your doctor, nurse, or pharmacist. Reach out for support—and continue to look for it. That includes housing and job opportunities if you need them! Anti-stigma efforts are also becoming more important for HIV care.
7. What is drug resistance?
If treatment is taken incorrectly, the virus might mutate (make changes in its viral genetic structure). This can make therapy less effective or even ineffective. This drug resistance occurs mostly through missed doses. Fortunately, many of the widely used HIV drugs today have a high barrier to resistance. However, it is better to avoid missing doses. Drug resistance may lead to the need for more complicated therapy (such as more pills or more drug classes).
8. Which drugs should I use?
HIV treatment is based on considerations such as health status (for example, kidney or liver disease) and lifestyle. See considerations for therapy in the DHHS guidelines.
9. How can I address my concerns?
You can play an active role in your health care by talking to your doctor. Clear and honest communication between you and your physician can help you both make smart choices about your health. It’s important to be honest and upfront about your symptoms even if you feel embarrassed or shy. Have an open dialogue with your doctor—ask questions to make sure you understand your diagnosis and treatment. While ARV regimens are usually well tolerated, each ARV can have side effects. Some may be serious. Refer to the drug page for each individual drug. Each person is different, and you and your health care provider will have to decide which drugs to use.
Here are a few tips that can help you talk to your doctor and make the most of your appointment:
- Write down a list of questions and concerns before your appointment.
- Consider bringing a close friend or family member with you.
- Take notes about what the doctor says, or ask a friend or family member to take notes for you.
- Learn how to access your medical records, so you can keep track of test results, diagnoses, treatments plans, and medications and prepare for your next appointment.
- Ask for the doctor’s contact information and their preferred method of communication.
- Remember that nurses and pharmacists are also good sources of information.
10. What is AWP?
The Average Wholesale Price (AWP) is listed on each drug page and is a way to compare costs of drugs. It is not what you would pay if you were to pay the full retail price. That’s why it’s commonly referred to as “ain’t what’s paid.” In the drug cost-sharing and patient assistance program charts (beginning on page 65) we include information on how to access programs that can help cover all or part of the costs of these medications.
11. What are PEP and PrEP?
PEP and PrEP are not HIV treatment, but are HIV medications used by HIV-negative people to prevent infection with the virus. “PEP” stands for “post-exposure prophylaxis” and is taken for 28 days following a potential exposure to the virus. “PrEP” stands for “pre-exposure prophylaxis” and is taken daily to ward off HIV infection. “Prophylaxis” means “preventative.”
12. More information online
See considerations for therapy, including information on COVID, and drug factsheets from DHHS at HIVinfo.nih.gov. Download iPhone and Android apps that provide drug info, guidelines, and a glossary: clinicalinfo.hiv.gov/en. The International AIDS Society also produces HIV treatment guidelines. Go to iasusa.org/resources/guidelines. To see if your HIV drug interacts with another medication, both prescription and over-the-counter, go to hiv-druginteractions.org. A good community-based source of information, besides Positively Aware, is aidsmap.com.