A combination of drugs can keep HIV under control by stopping it from reproducing itself. The goal is to keep levels of HIV so low that in tests they are ‘undetectable’ (‘undetectable’ doesn’t mean HIV is not there, just that the level is too low for tests to pick up).
The lower the amount of HIV, the better for someone’s health (it also means they are less infectious). But the drugs are not a cure for HIV because they cannot completely rid the body of the virus as it lives on in parts of the body that drugs can’t reach. For this reason life long treatment is needed.
Thanks to HIV drugs, doctors now see the infection as something that people can live very well with for a life time. This is especially true if they are diagnosed in good time and start medication (before the virus does too much damage to their immune system). In that case a person can expect to live more or less as long as someone who doesn’t have HIV. Thanks to medication, HIV-related illness and deaths have dropped dramatically.
When to start treatment
Someone who tests HIV positive may not need treatment straight away. It may be several years before medication is necessary but most people sooner or later need to start treatment. Doctors monitor the level of a person’s CD4 cells (blood cells which help the body fight off disease but are attacked by HIV). Once the level of CD4 cells drops below a certain point treatment is strongly advised. Treatment is working well if tests show someone has a high number of CD4 cells and a low level of HIV in their body.
People take far fewer pills now than in the past, sometimes just one or two a day. However many pills are needed, once treatment starts they must be taken every day. Sticking to the daily dose is called ‘adherence’ and good adherence is vital if treatment is to work.
If even just a few doses are missed levels of drugs in the body fall, allowing HIV to develop resistance to them, meaning they stop working as they should. That’s why it’s so important that the pills are taken every day and on time; the drugs need to be taken as instructed at least 95 per cent of the time. If a dose is missed take another as soon as you remember. But repeatedly missing doses risks your treatment failing and the need to switch to a different drug. If someone has problems with their treatment support is available from your HIV clinic and www.myhiv.org.uk
HIV drugs have become more effective and easier to take. Earlier problems with side effects (such as visible changes to the face and body) are no longer a problem. People may experience side effects during the first weeks of treatment (eg, headache, diarrhoea or feeling sick or tired) but once your body gets used to the drugs these should get better or go away.
You and your doctor can work together to minimise side effects; other medication can be given to help and, if necessary, a drug can be changed. Although there can be health issues related to taking HIV drugs, these are monitored (and treated if need be). The risks of not taking HIV medication are far greater than any risk from being on treatment.
Without treatment serious illness and death will follow within a few years for nearly everyone with HIV.
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