One of the most important discussions you will have with your HIV specialist concerns the choice of anti-HIV drugs for a first combination. The choice of anti-HIV drugs should be guided by your wishes as well as those of the doctor.
There are a variety of possibilities and you and your HIV specialist should try and work through them to give you as much choice as possible.
Different drugs require different regimens (what combination, when and with what they can be taken). It may not be possible to get a perfect combination that fits in with all aspects of your lifestyle; that is, one that makes everything easy for you. It becomes a trade-off of what you are prepared to lose or give up and what you are not. Do not allow yourself to be rushed into accepting a particular drug combination. Ask what options are available.
If you have questions, ask your HIV specialist for a full explanation. You should only begin anti-HIV therapy when you are ready. If you have questions or worries about how the anti-HIV drugs you are taking are affecting your health or your ability to live normally, talk them through with your HIV specialist. Do not stop taking any drug, or drugs without telling your HIV specialist.
Support for beginning therapy
All HIV specialists recognise that people need support on a wide variety of subjects when they first start anti-HIV therapy. People need to understand how and when to take anti-HIV drugs; any side effects of these drugs; possible interactions between anti-HIV drugs and other drugs, including recreational drugs; how to remember to take the drugs (adherence) and where to get support about taking anti-HIV therapy.
Taking all your medication reguarly and on time is very important, but can be difficult. Consequently, people should always be offered support around adherence.
Doctors are often very busy and so they may not always be able to offer all the support needed themselves. However, they should always give you basic information, and refer you to other people – clinical nurse specialists, pharmacists, dieticians, support groups or services – who may be able to give more in-depth help. Research has shown that there is a clear correlation between people getting information they can understand about treatments and enough support, and being able to manage their treatment.
Sometimes it may be necessary to consider changing the combination of anti-HIV drugs that someone is taking. If viral replication is shown to be consistently present by detectable viral load measurements and if other options are available which could further suppress viral replication or eliminate severe side effects, therapy should be changed.
Consequently viral load tests and clinic visits will need to be made more frequently when changes in treatment are being considered. There are a number of reasons why a particular combination of anti-HIV drugs fails. These include poor adherence to the drugs and sub-optimal blood levels of anti-HIV drugs.