Treatment Decisions

Treatment options should be explored using all the available information, scientific and anecdotal, that you can get. There are 3 possible strategies for treating HIV infection and it's effects:

Anti HIV/viral drugs

In the UK there are a number of licensed drugs which specifically target HIV at different points in its lifecycle. Although it is clear that these drugs can considerably improve the quality and quantity of life in HIV+ve people they all have varying levels of side effects, in a proportion of people. To compensate for this, certain drugs are taken in combination, both to reduce side effects but also to increase the effectiveness of each drug. There is no right or wrong time to start combination therapy, your doctor will discuss the options with you, but it will be up to you to decide, so the more information you have the better. For more information on these drugs refer to our HIV+ve contacts page

Treating or preventing opportunistic infections

People who have a low CD4 count or who are particularly susceptible to infections may be offered Prophylaxis (taking maintenance doses of certain drugs to try to control or prevent other infections). This may be of use to those who are newly diagnosed and want to delay taking anti-HIV drugs until they absolutely have to.

Strengthening or restoring the immune system

There are also drugs being developed that help to strengthen your immune system, but these may also have side effects. Many people with HIV also choose to use Complementary Therapies to support their immune system, these can include massage, homeopathy, reflexology, kinesiology, acupuncture, meditation, etc. Apart form treating physical symptoms, most of these therapies help to deal with stress, relaxing and refreshing you in the process. In Brighton Body Positive provide a range of complimentary therapies and have a vast experience of these therapies use and effectiveness.

Anti-HIV Drugs and HIV Resistance

What is resistance?
HIV reproduces itself very quickly, making billions of new viruses everyday. Because it often makes errors while copying itself, each new generation of viruses differs slightly from the one before. Some of these errors produce viruses which are defective and so can't reproduce themselves well. Over time these 'less fit' viruses will die off. However, some changes to the structure of the virus can also improve its ability to reproduce despite high levels of anti-HIV drugs being present. Viruses which are able to reproduce while you are taking drugs are said to be resistant to those drugs.

Researchers estimate that every possible error that might appear in HIV's structure occurs once every day if virus production is not being suppressed. This means the seeds for a drug resistant crop of viruses are being sown every day, and these viruses will be the ones which grow best when you start taking anti-HIV treatment.

If you're not taking treatment, then the population of viruses in your body will be influenced only by which viruses are most 'fit' to reproduce themselves. Resistant viruses will form only a tiny part of this population. Starting a drug combination creates the conditions in which pre-existent resistant viruses gain a competitive advantage over viruses which are sensitive to the drugs. To put it another way, the drugs themselves do not cause viruses to become resistant - resistant viruses existed before the drugs came along.

How does resistance affect treatment?
When you take anti-HIV drugs, HIV that is vulnerable to the drugs will be suppressed. This leaves behind viruses which can continue to reproduce despite the the drugs' presence. Over time, the pool of HIV in the body changes to include fewer drug sensitive viruses and more and more resistant ones.

Resistance is an important reason why anti-HIV drugs may have only limited or short-term usefulness. Your viral load, which usually drops when you start anti-HIV treatment, may rebound (bounce back) if a resistant virus population emerges.

It is not clear how developing resistance will affect your risk of becoming ill in the future. It's important to remember that resistance is a sign that your current treatment has failed to keep viral load fully suppressed, but that any reduction in viral load is associated with a benefit in terms of improved health and survival.

Cross resistance
Becoming resistant to the anti-HIV drugs you are taking has implications which may go beyond the failure of your current combination. This is because viruses which are resistant to one drug are often resistant to other similar drugs as well. Changing to a new drug combination in these circumstances could be difficult, as there may be few treatment options available which might be able to control all of the viruses in your body.

This problem is called cross-resistance and it seems to affect all anti-HIV drugs to a greater or lesser extent.

Limiting the risk of resistance
The following points give a brief outline of measures you can take to reduce the risk of resistance:

• The chance of developing resistance will be reduced if your viral load on treatment is undetectable, and you take every dose of the drugs prescribed to you
• The more you miss doses, the more likely it will be that your drug combination will fail.
• Some people contract HIV which is resistant when they become infected.
• Resistance tests are a new development which are likely to become important in helping you and your doctor select anti-HIV treatments in the future