By Frank Spinelli, M D
Originally published on Advocate.com October 26 2009 9:00 AM ET
Whenever I diagnose someone with HIV, inevitably the first question asked is, "Do I have to go on medication?" This is a far cry from 10 years ago, when the first thing every new seroconverter asked was, "Am I going to die?"
Yes, HIV is a chronic disease, but it is a widely held belief that a person who contracts HIV has the potential to live a full life, provided they take care of themselves and manage their HIV. That usually means going on antiretrovirals (ARVs).
The Department of Health and Human Services has established guidelines for starting patients on ARVs. Currently, the guidelines recommend initiating ARVs in those individuals who have a CD4-cell count of 350 or less. It is my opinion that these guidelines will change and that ARV initiation will soon begin earlier than the current guidelines suggest. Considering that your first option is often your best and that you will likely be taking ARVs for the foreseeable future, deciding on an initial regimen is becoming more important than ever before.
With all the medications you have to choose from, where do you begin?
Hopefully, you have made a wise first decision in choosing an experienced health care provider. Trusting your doctor and feeling comfortable with him or her is paramount. Any doctor who tells you what to do without taking into consideration your ethics and beliefs is wasting your time. I have treated many patients who do not feel comfortable taking medication, and writing them prescriptions and showing them the door is a disservice to their wishes. Of course, patients should understand that their doctor’s opinion is extremely valuable.
Choosing a first regimen or deciding when to switch is something you and your doctor should agree on. I recommend that when it comes time to decide on which regimen is right for you, try to consider what would best facilitate your ability to take these pills on schedule. Consider your lifestyle. Do you travel often and cross time zones? Ask which meds need to be taken with food or on an empty stomach. Is refrigeration required? Of course, you also have to factor in whether you are taking other prescription medications.
Never feel pressured into starting ARVs unless you are in an advanced stage of AIDS or have an opportunistic infection. Remember, this is a commitment and you have to be on board with taking these meds every day. There are consequences to misses doses.
Once you’ve begun, keep regularly scheduled appointments including routine laboratory work to track your T cells and HIV viral load. And be sure to tell your doctor about any side effects you may be experiencing. With all the options we now have to choose from, hopefully you and your doctor can find the one that is best for you.