There are many factors that must be considered when you and your health-care team think about treatment. Some of the main factors that need to be considered when deciding to start treatment include:
- Your history (time since diagnosis, symptoms, co-infections)
- Your CD4 count
- Your viral load
- If you are a woman it is also important that you think about pregnancy and your plans for pregnancy when you are considering the choice of medication to be used.
Starting treatment is not just about ‘medical reasons’. You have to be ready to take the medications all of the time in order for them to work effectively. Talking with your health-care team, your support network, and some of your peers living with HIV might help you make the right choice about starting treatment or not.
If your health-care team thinks you should start treatment and you feel ready to do so, the next step is to choose the ‘right treatment’. There is no single ‘best’ treatment combination. You and your health-care team need to decide on a combination that will work for you.
Three important words for you to remember as you learn to manage your HIV medications are:
(how well does it work to lower your viral load and increase your CD4 count)
(how long does it remain effective)
(how easy it is for you to take the medications, what side effects may occur and how serious are they).
Nucleoside, Nucleotide & Non-Nucleoside Reverse-Transcriptase Inhibitors (NRTI,
NtRTI and NNRTI)
- HIV is a single stranded RNA virus. In order to make more copies of itself in a ‘host’ cell (cells of humans that are infected) it first needs to change into a
double stranded DNA. Are you still with me?
- Reverse transcriptase is the enzyme that changes the single RNA strand of the virus to a double stranded DNA copy.
- The double stranded DNA copy is then joins the DNA in human cells; once this happens the virus can make lots of copies of itself.
- Medications that fall into the reverse transcriptase “RTI” category block the virus reverse transcriptase enzyme and prevent the virus from copying itself.
Nucleoside Reverse Transcriptase Inhibitors (NRTI’s)
NRTI's were the first class of anti-retrovirals to be discovered. In the body they are changed into nucleotides (the building blocks of DNA).
Click on the following link to get pronunciations, images and links for more information on these types of medications.
Nucleotide Reverse Transcriptase Inhibitors (NtRTI’s)
NtRTI's do not need to be activated before they can work as they are already nucleotides. Tenofovir is the only NtRTI currently in use.
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI’s)
NNRTI's were the third class of anti-retrovirals.
Protease Ihibitors (PI’s)
- Protease Inhibitors work by blocking the action of “proteases”. Proteases are enzymes that HIV uses to process viral proteins in one of the final steps of
- By inhibiting the function of the viral protease the PI’s prevent the virus from becoming a mature functioning virus
- Protease Inhibitors were the second class of antiviral medications developed.
- Most PI’s are “boosted”, meaning they are combined with a low dose of ritonavir. This increases the amount of the PI in your blood and helps it work
The following link will provide you with pictures, pronunciations and links for more information on Protease Inhibitors (PI’s).
Entry inhibitors or fusion inhibitors
- This class of medications interferes with the binding, fusion and entry of HIV into a human cell.
- By blocking this step HIV is prevented from entering cells and therefore it cannot replicate.
- Another enzyme that the virus needs is called integrase. This enzymes is needed to incorporate the double stranded DNA (made by reverse
transcriptase) into the human cell chromosome (DNA).
- The integrase inhibitors block the action of the viral integrase, which prevents the virus from making more copies of itself.
Combination therapy and combination roduct
- Most of the time HIV treatment consists of taking 3 or more types of medication.
- A combination of three or more anti-HIV medications is sometimes referred to as Highly Active Antiretroviral Therapy or “HAART”.
- Using HAART (3 or more medications together) decreases the chance that resistance will develop, making the treatment more effective in the long term.
- A common advantage of the combination products is lower pill count per day.
- If you are able to swallow pills you may be able to use these combination pills in your treatment.
How to take your medications
Each medication has different dosing, and frequency. Guidelines tell you how and when to take the medication. It is important to speak with your health-care team about the specifics of each medication so you can follow these rules. The first step in remembering to take your medications independently is to create a routine with reminders that will help you.
Your medications will only work if you remember to take them and remembering to take them at the right time everyday is tricky. Sticking to the schedule (adherence) can be difficult but is important for your long term health. Becoming more independent in managing your medications is an important step as you prepare for adult health-care.
The importance of not forgetting
If you miss doses of your medications, the virus can replicate more easily. This will lead to an increase in the amount of HIV in your blood (viral load). When this happens the virus can become resistant to the medication you are taking and to your immune system being further damaged. A few missed doses can be enough for this to happen. If the virus becomes resistant to the medications you are on, other antiretroviral medications that work in a similar way (same medication type) may also become inactive. It is important NOT to stop medications without speaking to your doctor.
Tips to remembering medications
- Write a list with the medications, time and date and tape the list to the mirror in your bathroom. You can also print this on a grid and check off each medication after you take it.
- Put the pill bottles where you will remember them at the time of day they are scheduled. For example, put your morning dose beside your alarm clock.
- Use a pill box (dosette) to help you organize and remember to take your medications.
- If you use a computer, download ‘sticky notes’ to have a reminder on your desk top.
- Set alarm times on your cell phone or mobile device to go off when medications are scheduled.
Most people do not have side effects from the anti-HIV medications. When side-effects do happen they can range from very mild to very severe. Every medication has its own unique side effects but there are some common ones worth learning about. For unique side effects, refer to the information sheets for each medication.
Common side effects
Stomach or bowel problems are the side effects that are noticed the most often by people taking HIV meds
- Includes nausea, vomiting, loss of appetite, diarrhea, and excess gas.
- The health-care team may call these GI symptoms.
- HIV disease can also cause digestive problems.
- Some tips: eat small but frequent meals, eat salty snacks before medications, eat cool, bland, odourless foods.
- Skin rash is another relatively common side effect of antiretroviral medications.
- In many cases the rash is mild and resolves over time without stopping the medication.
- However, in some cases rash can be a serious side effect; for this reason, you should let your doctor know about a new rash, especially if it appears within 1-2 months of starting a new medicine.
Less common side effects
- Before starting any anti-HIV medication, tell your doctor about any allergic reactions to other medications you have had
- A rash caused by anti-HIV medications is usually mild or moderate and therefore not dangerous. However, in rare instances, the reaction may progress to a more severe level and have more serious consequences. A more severe allergic reaction could be a rash that is accompanied by fever, nausea or vomiting, blisters, muscle or joint pain.
- This is why it is recommended that you see a doctor if you get a rash.
Uncommon side effects
- Very rarely, anti-HIV medications may cause damage to the liver.
- Symptoms may include nausea and vomiting, abdominal pain, dark coloured urine, yellowing of the eyes or skin.
- The damage can be reversed if the medication is stopped early enough.
- You will have regular blood tests to monitor the effect of the drugs on liver function.
- To protect your liver, avoid consuming large quantities of alcohol or drinking on a regular basis, and also avoid using recreational drugs.
Managing side effects
Always talk with your health-care team as soon as possible about any symptoms you have that might be a side effect of a medication. If the side effect is not too serious, waiting it out may be an option. Sometime side effects improve or go away altogether on their own.
If the side effect is severe, or is too bothersome to you, the medicine may need to be stopped.
Make sure your health-care team knows all the medications and supplements (such as vitamins, herbal medicine) you are taking because sometimes side effects can be due to interactions between medications.
You should speak to your health-care team about possible side effects before starting any new treatments (including natural and herbal).
- Antiretroviral medications may have interactions with other medications.
- Other medications may lower or increase the effect of antiviral medications, or in some cases, the antiviral medication may lower or increase the effect of other medications.
- Keep a list of all medications you are taking, including other prescription medications, medications that you can buy in the pharmacy without a prescription, and vitamins or herbal supplements.