Advances in HIV Treatment: Understanding ART

From the WebMD Archives

Antiretroviral therapy -- or ART -- revolutionized HIV treatment in the past few decades. And newer improvements, like one-pill-a-day drugs, are making life with HIV easier and safer.

"HIV really is a chronic disease now," says Brad Hare, MD, medical director of the HIV/AIDS Division at San Francisco General Hospital. "It's like diabetes or high blood pressure." As long as you manage it well, you should expect a long, healthy life.

Understanding ART

ART works by combining drugs that attack the virus in different ways. ART doesn't cure HIV. But it stops it from reproducing itself and spreading.

Doctors measure HIV by the viral load -- that's the amount of the virus that's in your bloodstream. The goal of treatment is to get the viral load so low that tests can't even detect the virus anymore. HIV is still there, but there's not enough of it to cause symptoms -- as long as you keep taking your medication. Also remember that you can still pass HIV to someone else while on medication.

5 Things to Know About HIV Medications

There are lots of myths and stale, outdated information about HIV treatment. Here are five things you should know about ART.

  • It's easier to take than it used to be. A lot of people with HIV just take one pill once a day. That's it. That one combination pill -- Atripla, Complera, or Stribild -- packs in all the different active ingredients you need. Most people don't need the "cocktails" with complicated dosing schedules anymore.
  • You have lots of options. Some people need drug combinations. There are six classes of antiretroviral drugs for HIV and more than 30 drugs. If one doesn't work or causes side effects, the doctor has many other choices.
  • Medications work for a long time. People used to worry that their drugs would stop working after a while and that they'd have to keep switching to new ones. That's not really a risk now. "As long as you keep taking your medications, the same treatment can work for decades," Hare says.
  • Drugs have fewer side effects. While specific side effects depend on the drug, HIV treatment is much safer and easier to tolerate than it used to be. For most people, side effects -- like upset stomach and diarrhea -- are minor and often go away. Long-term risks include cholesterol problems and weakened bones. But even so, the risks of treatment are much lower than the risks of not getting it, Hare says.
  • You may start taking medication as soon as you're diagnosed. Many experts believe that the sooner you start treatment, the better. However, some doctors prefer to wait until your CD4 count, a measure of some immune cells, drops to a certain point before starting treatment. See what your doctor recommends.

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Choosing a Medication

Doctors have quite a few good medications to choose from. So they'll tailor your treatment to you specifically. The right treatment can depend on:

  1. How organized you are. Do you have trouble remembering to take medication? Some treatments are better for people who are more likely to miss a dose now and then.
  2. Your eating habits. You have to take some drugs with food. If you have a very irregular eating pattern, some drugs might not be a good fit.
  3. If you want to get pregnant. Atripla contains the drug efavirenz and isn't safe for women who are breastfeeding, pregnant, or planning to get pregnant.
  4. Other health considerations. Some HIV medications can interact with other drugs, like medications for acid reflux. If you have high cholesterol, heart disease, or other issues, your doctor will opt for the medication least likely to cause problems.
  5. Viral resistance. You'll get a test to show if the strain of HIV you have is resistant to any drugs. If it is, you'll use other medications instead.

Staying on Track

Once you're diagnosed, it’s very risky for you to stop taking your medication, Hare says.

There are lots of reasons this happens. You might switch doctors. You might lose your insurance coverage for a time. Some people deliberately go off their medications because they mistakenly think they're cured, Hare says.

But even if you're feeling well, it's crucial that you stay on your medication. Stopping treatment gives the virus a chance to spread and cause serious problems.

HIV is now a manageable disease. But you have to do your part to manage it -- and that means sticking with treatment.

WebMD Feature Reviewed by David T. Derrer, MD on December 12, 2013

Sources

SOURCES:

John G. Bartlett MD, professor of medicine, Johns Hopkins University; former director of the Johns Hopkins AIDS Service.

Brad Hare, MD, medical director, HIV/AIDS Division, San Francisco General Hospital; associate professor of medicine, University of California San Francisco.

Michael Melia, MD, assistant professor, Johns Hopkins University School of Medicine.

AIDS.gov: “Viral Load,” “Overview of HIV Treatments.”

AIDSinfo.nih.gov: “12 Side Effects of HIV Medicines,” “When to Start Antiretroviral Therapy,” “When to Start: Selecting a First HIV Regimen.”

National Institute of Allergy and Infectious Diseases: “Treatment of HIV Infection,” “Types of HIV/AIDS Antiretroviral Drugs.”

UpToDate: “Acute and early HIV infection: Treatment,” "Selecting antiretroviral regimens for the treatment naive HIV-infected patient."

U.S. Department of Veterans Affairs: “HIV/AIDS: FAQ.”

U.S. Preventive Services Task Force: “Screening for HIV."

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