Strategies for HIV therapy

April 2008 View PDF En español

When is it time to change therapies?

People might change therapy when:

HIV levels become detectable after being undetectable;
HIV levels remain detectable after 4–6 months of starting therapy;
Continued decreases in CD4+ cell counts;
Intolerable side effects occur;
Adherence is poor;
There is less than a 0.5–0.75 log (3- to 6-fold) reduction in HIV levels after four weeks or less than 1.0 log after eight weeks of starting therapy (as noted above, however, for people who start HIV therapy when their CD4+ counts are low and HIV levels are high, it may take longer to realize the effectiveness of a regimen); or
Symptoms of HIV disease occur.

A common infection such as the flu, or even a vaccine shot, can increase HIV levels temporarily. (A flu vaccine can increase HIV levels for up to two months, but they usually fall back to pre-vaccine levels without changing HIV therapy.) Before making a dramatic adjustment in your regimen, factor in how other health issues may be affecting the viral load test results. If possible, wait and get another test before making decisions. The decision to switch or add therapies should be based on at least two viral load tests and/or two CD4+ counts spaced at least two weeks apart, as well as other factors like the readiness to switch and commit to a new regimen.

Write down a list of questions and concerns that you may have for your doctor. It’s also helpful to discuss your feelings about taking therapy, especially for the first time. Some of those questions may include:

How do I know whether I’m ready to start therapy?

What I think will happen to me after I start therapy is …
What will happen if I don’t start therapy?
Is it possible for me to wait?
How I feel about starting therapy is ...

It’s probably helpful to keep a list of other questions you may have. Some of these may include:

How potent is this regimen?
What are the side effects of the various drugs, and how often do they occur?
Is there anything I need to do if side effects occur?
How do I monitor for these side effects? Are there things I can do to reduce the risk of getting them?
How often do I need to come in to check and see if my therapy is working?
How often should I take these drugs?
What doses should I take?
Do any of these drugs require a dose change based on my weight or liver or kidney functions?
Are there any interactions between these drugs and other drugs, herbs, vitamins or supplements that I take?

Other questions for people who may also have hepatitis B or C may include: