Strategies for HIV therapy

April 2008    View PDF    En español

Commentary

In addition to issues like your overall general health and quality of life, both CD4+ counts and viral load must be considered when making decisions about starting or switching HIV therapy. Most studies show a direct inverse correlation (when one goes down the other goes up) between viral load and CD4+ counts as more HIV means more CD4s are being infected and destroyed.

Some people, despite substantial decreases in their HIV levels, may continue to experience a decline in their CD4+ counts. In these cases, it’s important for doctors to conduct a more extensive diagnosis to see if some other condition is affecting CD4+ counts, such as common or even not so common infections.

It is usually best to start two or more new drugs at the same time. This is readily done for people starting first line therapy but far more difficult for those who have used many other HIV drugs. Your current regimen can sometimes be juggled to get the desired results. For some, this may be impossible.

Everyone does not have access to the same treatments, and people respond differently to individual drugs. Options for treating HIV disease include approved HIV drugs and combinations, experimental drugs gotten through studies or access programs, and other unapproved drugs. Consult with your health provider about how to access the full range of options.

For some people, the best choice may sometimes be to delay using new HIV drugs until enough new drugs are available to start an ideal combination (e.g. at least two drugs never used before by the person). The pace of new drug development is never wholly predictable, which makes this strategy difficult. Working with an experienced doctor who continues to learn from new research is key.

This shift toward long-term thinking is the true hallmark in this third decade of treating HIV. It must become a part of everyone’s thinking. The alternative is perpetuating the short-term benefits and long-term failures that were qualities of treating HIV disease earlier in the epidemic.

All of this underscores the fact that people who get medical care from doctors with a great deal of experience in treating HIV disease live longer than those with less experienced ones. HIV is both complicated and extensively studied. A doctor who sees many people with HIV is more likely to understand these complexities and follow the heavy volume of research. Whatever strategy a person chooses, it should begin with finding an experienced doctor who is wise enough to continue studying and learning from new developments in HIV research.