SlideShare a Scribd company logo
1 of 28
Download to read offline
BOOKLET 2 OF 3
JANUARY 2013
Considering treatment
and your health care
your life matters
HIV HEALTH & WELLNESS
Table of contents
Using this booklet ... 2
How is today different from earlier in the epidemic? 3
KNOWLEDGE: Understanding the details of treatment
Why take HIV medications? 4ā€“5
Choosing the best time to start 6ā€“7
When to start: CD4 count ranges 8
Classes of HIV meds 9
Recommended regimens for first line treatment 10
A few things about your first regimen 11
Understanding test results 12
Resistance testing before starting 13
HEALTH: Your ability to start and maintain
Women and HIV infection 14ā€“15
Are you ready to start? 16
Side effects from HIV meds 17
Drug interactions 18
SELF-ADVOCACY: Getting ready to start
Getting your health care covered 19ā€“21
Is your doctor experienced in treating HIV? 22
Important questions to ask others 2
RESOURCES:
Checklist for getting started 24
HIV Health & Wellness: Considering treatment and your health care 1
Using this booklet ...
The main focus of this booklet is to get you thinking about
HIV and your health. Because treating HIV can be complex
and because only you can take the medicines your body
needs, your ability to commit to the meds are a critical part
of your health decisions.
Getting the earliest treatment is generally recommended
for most illnesses. HIV may not be any different; except that
once itā€™s started, treatment is for life. On one hand, deciding
the best time to start HIV meds is a matter of personal
choice. On the other, study results increasingly lean toward
starting earlier.
Some experts believe that starting meds is appropriate
immediately after finding out your diagnosis. Waiting
might allow HIV to progress further and do more damage
to your immune system and to other body systems and
organs such as your heart, blood vessels and kidneys.
At a minimum, most doctors would agree that itā€™s neces-
sary to start meds when HIV symptoms are present, your
CD4 count is falling, or your viral load is high and rising.
HELPFUL RESOURCES
Just Diagnosed Resource Center www.thebody.com/content/art49985.html
HIV Health & Wellness: Considering treatment and your health care2
HIV Health & Wellness: Considering treatment and your health care 3
How is today different
from earlier in the epidemic?
Treating HIV is very different today
than what it was earlier in the epi-
demic. People are now healthier and
living longer on HIV meds, and
many can start with a full regimen
of just one or two pills taken once
or twice a day. There are fewer food
restrictions, and drugs are generally
easier to take and tolerate.
Perhaps some of the things you believe about todayā€™s
medicines are not ā€” or are no longer ā€” true. Concerns
still linger in the community about severe side effects and
how someone might look after being on meds for awhile.
Newer regimens generally have fewer and more manage-
able side effects. The drugs that caused the most problems
are rarely used for people starting treatment in the US.
Over the years, public health care programs as well as
private health insurance have greatly improved their HIV
care, allowing more people to find and pay for stable medi-
cal care. The medical community also has a great deal more
experience treating HIV today.
Although most people donā€™t have outward symptoms
of HIV for many years without being on treatment, itā€™s
extremely rare that the immune system can fully sup-
press HIV on its own. The longer you have untreated
HIV the more damage it can do, making you more
susceptible to infections and other health problems.
IMPROVING QUALITY OF LIFE
Being on HIV treatment
should interfere as little as
possible with your quality
of life. It should be easy
enough to use so you can
take every dose as prescribed. For most people, itā€™s
possible to find a regimen that works well with mini-
mal side effects or drug interactions. If you cannot
tolerate a drug or the regimen isnā€™t working for you,
itā€™s possible to switch to other options.
IMPROVING IMMUNE FUNCTION
Taking HIV treatment normally produces a higher
CD4 count. Some people experience a rapid rise in
their CD4s after starting treatment, but for others the
increase may take more time. This is especially true if
you wait to start treatment until your CD4 counts are
very low, such as below 100.
Why take HIV medications?
HIV Health & Wellness: Considering treatment and your health care4
HIV Health & Wellness: Considering treatment and your health care 5
REDUCING VIRAL LOAD
HIV treatment makes it easier for the immune system to
control HIV. The goal is to keep HIV levels as low as
possible for as long as possible, preferably below 50 copies
(called undetectable). The minimum change that shows
treatment is working is lowering your virus level by 90%,
or a 1 log decrease (such as 10,000 down to 1,000).
REDUCING DRUG RESISTANCE
When HIV is fully suppressed by HIV meds, itā€™s less
likely to change and become resistant to the drugs.
Taking every dose as prescribed and staying undetect-
able can help prevent resistance. Most commonly
used HIV meds are so good now that theyā€™re able to
overcome drug resistance for many years even with
one or two doses missed every once in a while.
HELPING PREVENT TRANSMISSION
People who take HIV meds and stay undetectable are
less likely to transmit HIV. However, even with good
adherence to an HIV regimen, thereā€™s still some risk in
transmitting HIV ā€” for
example, active sexually
transmitted diseases
(herpes, syphilis, etc.)
can increase the risk. Itā€™s
important to continue
engaging in safer sex.
HIV Health & Wellness: Considering treatment and your health care6
The following factors can help you and your provider
choose the best time to start treatment.
YOUR CD4 COUNT TREND
A trend is when you
look at two or more
CD4 count results to
see how much they
change. Over time,
falling CD4s indicate
declining immune
health. A loss of 100
CD4s or more each
year shows a weakening immune system. Donā€™t panic
about a single lower test result, but consult with your
doctor and consider another test to determine your
trend. (Read more on page 8.)
YOUR VIRAL LOAD TREND
Increasing HIV levels over time indicate that the virus
is reproducing and can infect more CD4s. Again, the
trend is important: consider two or more test results
to inform a treatment decision. Experts generally agree
that viral load rising above 100,000 is a sign to start.
Choosing the best time to start
HIV Health & Wellness: Considering treatment and your health care 7
YOUR GENERAL HEALTH
If your health is good and stable, then starting treat-
ment right away may not be necessary. But if you
have some symptoms of HIV disease, despite a good
CD4 count, starting is usually the right decision. On
the other hand, if you have an illness that may make
it difficult to take HIV meds, it may be better to wait
until that illness has resolved. Your doctor can help
you make this decision.
ARE YOU READY TO START?
You should begin treatment when you feel youā€™re ready,
but you shouldnā€™t put it off until all your fear is gone.
Being ready includes being emotionally ready to com-
mit over the long-term, as well as being able to take
pills every day, manage possible side effects, and make
sure you have ongoing health care. It might also mean
dealing first with other issues such as finding stable
housing or mental health or substance use services.
THESE CONDITIONS INCREASE THE URGENCY TO START:
HIV Health & Wellness: Considering treatment and your health care8
STARTING TREATMENT BETWEEN 0ā€“350 CD4 CELLS
Waiting to start until a CD4 count drops below 350 puts you
at much higher risk of developing many health problems. These
can include conditions related to HIV (pneumonia, certain
cancers, etc.) and other conditions (heart attacks, kidney
disease, etc.). Almost all doctors would agree that people with
low CD4 counts should start treatment as soon as possible.
STARTING TREATMENT BETWEEN 350ā€“500 CD4 CELLS
The risk of getting sick isnā€™t quite as high in this range.
Fewer studies confirm the benefits of starting in this range
compared to lower CD4s. For this reason, you may have more
time to get ready to start. However, itā€™s important to under-
stand that some studies suggest your risk of getting sick is
higher if you donā€™t start in this range. Longer-term damage
to your body is occurring as long as HIV is not kept low.
STARTING TREATMENT ABOVE 500 CD4 CELLS
A couple of studies show a lower risk for getting sick in
people who start this early. Many other studies show that
early damage to your immune system and other parts of
the body happen when HIV isnā€™t well controlled ā€” no mat-
ter the CD4 count. As well, people who are on treatment
with undetectable HIV are much less likely to pass on HIV
to their sex partners. However, even though the risk of side
effects is much lower with modern treatment, taking meds
longer could increase your chance of developing certain
side effects. Itā€™s reasonable for someone to start above 500,
but the pros and cons should be carefully considered.
When to start: CD4 count ranges
HIV Health & Wellness: Considering treatment and your health care 9
Classes of HIV meds
Your first regimen will probably include three drugs from
two different classes. These classes work against different
steps in the life cycle of HIV. Using at least two classes to-
gether provides better and longer-lasting health.
Below is the current list of HIV meds, organized by class
and then listed by brand name, generic name and year of FDA
approval. Some drugs are no longer used or not used often
in the US, while others are used only in special situations.
NNRTIs (non-nucleoside
reverse transcriptase inhibitors)
Edurant (RPV, rilpivirine, 2011)
Intelence (etravirine, 2008)
Rescriptor (delavirdine, 1997)
Sustiva (EFV, efavirenz, 1998)
Viramune (nevirapine, 1996)
ENTRY INHIBITORS
Fuzeon (T20, enfuvirtide,
injectable, 2003)
Selzentry (maraviroc, 2007
FIXED DOSE COMBINATIONS
Atripla (TDF+FTC+EFV, 2006)
Combivir (AZT+3TC, 1997)
Complera (RPV+TDF+FTC,2011)
Epzicom (3TC+ABV, 2004)
Stribild (ELV+TDF+FTC, 2012)
Trizivir (AZT+3TC+ABV, 2000)
Truvada (FTC+TDF, 2004)
NRTIs (nucleoside/nucleotide
reverse transcriptase inhibitors)
Emtriva (FTC, emtricitabine, 2003)
Epivir (3TC, lamivudine, 1995)
Retrovir (AZT, zidovudine, 1987)
Videx EC (ddI, didanosine, 2004)
Viread (TDF, tenofovir, 2001)
Zerit (d4T, stavudine, 1994)
Ziagen (ABV, abacavir, 1998)
PIs (protease inhibitors)
Aptivus (tipranavir, 2005)
Crixivan (indinavir, 1996)
Invirase (saquinavir, 2003)
Kaletra (lopinavir/r, 2000)
Lexiva (fosamprenavir, 2003)
Norvir (ritonavir, 1996)
Prezista (darunavir, 2006)
Reyataz (atazanavir, 2003)
Viracept (nelfinavir, 1997)
INI (integrase inhibitor)
elvitegravir (ELV, 2012)
Isentress (raltegravir, 2007)
HELPFUL RESOURCES
AIDSMeds.com www.aidsmeds.com/list.shtml
HIV Health & Wellness: Considering treatment and your health care10
The Guidelines list ā€œpreferredā€ and ā€œalternativeā€ HIV regi-
mens. Research shows that ā€œpreferredā€ regimens are potent,
better tolerated and easier to take. These are listed below.
ā€œAlternativeā€ regimens are second choices but may work
just as well. These can be found in the Guidelines.
PREFERRED REGIMENS
NNRTI: Atripla (1x/day), 1 pill
Women should get a pregnancy test done before start-
ing this pill. One of the drugs in it, Sustiva (efavirenz),
can cause birth defects.
PI: Prezista/Norvir + Truvada (all 1x/day), 4 pills
PI: Reyataz/Norvir + Truvada (all 1x/day), 3 pills
People who are taking more than 20mg of omeprazole
(an antibiotic) should not start Reyataz.
INI: Isentress (2x/day) + Truvada (1x/day), 3 pills
This regimen is a little unusual in that one pill is taken
once a day while the other is taken twice a day. People
should not take both pills of Isentress 1x/day because it
does not control HIV as well as taking one pill 2x/day.
Pregnancy: Kaletra + Combivir (all 2x/day), 4 pills
 Ā 
more Ā recent Ā updates Ā to Ā the Ā Guidelines Ā for Ā preferred Ā regimens.
Recommended regimens for first
line treatment (updated March 2012)
HELPFUL RESOURCES
Guidelines for Treating HIV in Adults www.aidsinfo.nih.gov/guidelines/
HIV Health & Wellness: Considering treatment and your health care 11
The most powerful and long-
lasting control of HIV comes
from a personā€™s first regimen
if taken properly. The longer
a person can stay on it with-
out major side effects or drug
resistance, the better.
To tell if your regimen is
working, you should see a
90% drop in your viral load
within a month or two. (See
page 5.) Most people can reach an undetectable level within
six months, although it may take up to a year if youā€™re over 50
or have another condition like hepatitis C.
When a personā€™s viral load remains undetectable for at
least one year on treatment, it usually remains that way for
at least another two years, assuming they take their meds as
prescribed. Some people have been able to stay on their first
regimen for up to eight years without having to switch. This
is true for almost any regimen.
_______ MAIN POINTS TO REMEMBER _______
control of HIV.
should drop by at least 90%.
months.
A few things about your first regimen
HIV Health & Wellness: Considering treatment and your health care12
VIRAL LOAD TEST
A viral load test is used to check how well treatment is con-
trolling HIV. It measures the number of copies of HIV in
a small amount of blood. People starting treatment for the
first time usually see their viral load fall to an undetectable
level within 12ā€“24 weeks. Several things can influence this,
including taking the meds as prescribed and the potency of
the regimen. Higher viral loads may take longer to respond.
CD4 CELL COUNT
HIV treatment helps to preserve and increase your CD4
count, which means the immune system is getting better
at controlling HIV and other infections. The actual increase
will vary from person to person. If you start treatment with
a lower CD4 (below 200) it usually takes more time to reach
higher counts, or you may not see a large gain. Older people
and those with hepatitis C may also have smaller gains.
CD4 PERCENTAGE
The CD4 percentage shows the proportion of all white blood
cells that are CD4s, which in people living with HIV averages
about 25% or more. This marker tends to change less often be-
tween tests than the CD4 count, and it may be more reliable.
A decreasing CD4% over time shows a weakening immune
system, and one that falls below 14% is an AIDS diagnosis.
Understanding basic test results
HELPFUL RESOURCES
Blood Work www.projectinform.org/publications/bw/
Understanding Lab Results www.thebody.com/content/art14477.html
HIV Health & Wellness: Considering treatment and your health care 13
Resistance testing before starting
Drug resistance occurs when HIV mutates,
or changes enough so that a drug or
regimen doesnā€™t fully control it any-
more. Resistance usually occurs when
drugs are not taken as prescribed and
consistently on schedule. Some people
(about 1 out of 9 per year in the US) get
a strain of HIV with some level of resis-
tance. However, HIV is rarely resistant
to all HIV meds, so learning ahead of time which drugs it is
resistant to (if any) can help you choose the best regimen.
The US Guidelines recommend that people get a geno-
typic resistance test before they start or change treatment.
People who choose HIV meds guided by resistance test
results have better control of HIV over time. To run a resis-
tance test, you must have a viral load above 1,000. The test
cannot be done accurately if viral load is below 50 copies.
_______ MAIN POINTS TO REMEMBER _______
your doctor make better treatment decisions.
done when viral load is above 1,000.
HELPFUL RESOURCES
HIV Drug Resistance Tests www.projectinform.org/publications/resistance/
HIV Drug Resistance Mutations www.iasusa.org/resistance_mutations
HIV Drug Resistance Database http://hivdb.stanford.edu
14 HIV Health & Wellness: Considering treatment and your health care
HIV meds have not
been studied as much
in women. Some
questions remain
about the doses given
to women. Female
hormones may also
affect HIV meds.
However, the recommendations for when to start and
what to choose are generally the same for both sexes.
Women who are not pregnant, planning to become
pregnant, breast-feeding or taking hormonal birth
control can follow the same guidelines as men.
Women sometimes experience both a higher rate
and different types of side effects from HIV meds
than men, likely due to differences in their weight and
body size. In some cases side effects can persist longer
for women than for men, but usually decline over time.
Oral contraceptives can interact with some HIV
meds. Itā€™s not clear whether this actually raises the
risk of unintentional pregnancy, but some experts
recommend that prescriptions should be changed or
other forms of birth control should be used.
Women and HIV infection
HIV Health & Wellness: Considering treatment and your health care 15
With careful planning and ongoing care, pregnant
women can expect to have a safe pregnancy and to give
birth to an HIV-negative baby. Although HIV meds
have not been well studied in preg-
nant women, the US Guidelines rec-
ommend that all pregnant women be
on treatment to protect themselves
and their unborn babies. Some meds
appear to be safer, some can be more
problematic, and a few others should
not be used at all. When making
decisions around pregnancy, delivery
and nursing, itā€™s wise to consult an
HIV-experienced doctor, such as
an OB-GYN who has treated HIV-
positive women.
_______ MAIN POINTS TO REMEMBER _______
for women and men.
effects than men.
as birth control pills, pregnancy, delivery and nursing.
HIV Health & Wellness: Considering treatment and your health care16
Are you ready to start?
It can be hard to take medicines and stay on them when youā€™re
feeling well. Itā€™s easier to remember and take them when you
feel sick because you want to feel better. But HIV meds are
taken every day ā€” whether you feel good or feel bad.
Itā€™s difficult to fully grasp the meaning of ā€œlifelongā€ treat-
ment, but once you start HIV meds you need to stay on
them. How do you feel about taking pills every day? Have
you taken other medicines or vitamins long-term? How
about family or friends? What were their experiences?
Adjusting to several changes in your life at once can be
hard. You may want to avoid starting meds before disrupt-
ing life experiences like going on vacation, moving or start-
ing a new job. What flexibility do you have with commit-
ments like caring for children or volunteering? How will
you carry your meds?
Itā€™s generally better to not start until youā€™re ready rather
than to start and stop. Youā€™re the expert on when you can
start in a way that helps ensure your quality of life.
STIGMA
For many, privacy is an important consideration when
taking HIV medicines. Taking them on time every day
or going to regular doctor visits may raise suspicions of
some people in your life. Discrimination or disapproval
from others can make it challenging to take care of your-
self. When possible, discretely telling people who sup-
port you may help you stay healthier.
Side effects from HIV meds
Modern HIV regimens generally have
fewer and more manageable side effects,
and many people tolerate them quite
well. Although most people wonder or
worry about side effects, itā€™s impossible
to predict who will have them. Some
people have few or no side effects, while
others have ones that are more troublesome for them. The
side effects one person has from a particular medicine does
not mean everyone else will have the same ones.
Short-term side effects (headache, fever, nausea, etc.) nor-
mally appear during the first few weeks of taking a new drug.
They often get better or disappear as your body gets used to
the meds. They can reappear due to stress or other infections.
People with better overall health usually experience
fewer short-term side effects. If you start later when youā€™re
less healthy, you may experience more side effects. How-
ever, if your regimen interrupts your quality of life, you can
probably switch to another one that you can tolerate better.
You and your doctor will keep track of long-term side
effects with routine blood tests. These can include changes
in blood fats or in certain blood proteins (such as ALT,
AST, amylase and creatinine) that point to possible problems
with certain organs, including the liver and kidneys. Over
time, these changes can progress to other conditions like
more fragile bones or kidney and liver disease.
HIV Health & Wellness: Considering treatment and your health care 17
HELPFUL RESOURCES
Dealing with Drug Side Effects www.projectinform.org/publications/sideeffects/
HIV Health & Wellness: Considering treatment and your health care18
Drug interactions
Drug interactions are possible whenever you take two or
more drugs together, whether theyā€™re prescriptions, over-
the-counter drugs like cold medicine, recreational drugs or
even herbal products. Even food can interact with drugs.
The more meds you take, such as meds for high blood pres-
sure or even erectile dysfunction, the more likely you could
experience an interaction. This is also true about taking HIV
meds with some herbal products, especially St. Johnā€™s Wort.
Not only does each drug or herb have its own possible
side effects, they may also increase or decrease the effec-
tiveness of other drugs. Drug interactions are not always
considered when making treatment decisions, but they can
certainly play a major role in its success.
Make sure your doctor knows about all the drugs and
supplements you take, including over-the-counter products
and recreational drugs. Your pharmacist can also be a good
resource. Drug interaction tools are also available online.
_______ MAIN POINTS TO REMEMBER _______
drugs or herbal products.
meds to avoid or correct drug interactions.
HELPFUL RESOURCES
HIV Drug Interactions www.hiv-druginteractions.org
Medwatch www.fda.gov/medwatch
HIV Health & Wellness: Considering treatment and your health care 19
Getting your health care covered
You may never need to file for disability, but for simplicity we
present these options in terms of pre- and post-disability.
Disability is a formal claim that must be made with your
doctor and approved by Social Security. To find programs you
may be eligible for, itā€™s important to consult local resources
such as benefits counselors, case managers, social workers
or attorneys as programs differ greatly from state to state.
IF YOU HAVENā€™T FILED FOR DISABILITY ā€¦
GROUP INSURANCE THROUGH YOUR EMPLOYER
If your employer covers health care, the insurance company
must cover you even if you have a pre-existing condition like
HIV. There are three types of plans: fee-for-service, preferred
provider organizations (PPOs), and health maintenance
organizations (HMOs). Plans vary in what they offer, their
fees and your choice of doctors. Choose a plan that is best
for you, and check your plan for HIV-experienced doctors.
COBRA
If you leave work due to a layoff and had insurance, then
you should be offered a continuation policy called COBRA,
which is meant to sustain you until you get other insurance.
INDIVIDUAL PRIVATE INSURANCE
Individual plans are an option, but few people with HIV
can purchase them due to high cost and restrictions on pre-
existing conditions. If you had coverage before your HIV
diagnosis, itā€™s likely most or everything you need will be
covered. However, out-of-pocket expenses may be high.
HIV Health & Wellness: Considering treatment and your health care20
Getting your health care covered, cont.
HIGH RISK INSURANCE POOLS
This program covers people who canā€™t get insurance due to
pre-existing conditions and operates in 36 states. In addi-
tion, under health care reform each state has a Pre-existing
Condition Insurance Program (PCIP) in place until 2014
when the large coverage expansions will occur.
FEDERAL RYAN WHITE PROGRAM
Ryan White funds a broad range of HIV services in states and
localities, depending on their unique needs. Itā€™s intended
to help under- or uninsured people. If you have insurance,
you may get help with premiums or other out-of-pocket
costs. If you donā€™t have insurance, your state program may
help you purchase it. You may also get free or very low cost
care through HIV clinics and the AIDS Drug Assistance
Program (ADAP). Ryan White may also fund dental and
vision care. Check with your state AIDS program or ASO
to see if a Ryan White program can help you.
IF YOU HAVE AN APPROVED DISABILITY CLAIM ā€¦
COBRA
If you leave work due to disability and had insurance, youā€™ll
be offered COBRA until you can get other insurance like
Medicare. Coverage is often expensive. Check with a local
ASO or state AIDS office for programs to help with out-of-
pocket costs.
MEDICAID
Most people with HIV qualify for Medicaid through its
disability category, although some women with children
can qualify through a different program. Nearly all states
HIV Health & Wellness: Considering treatment and your health care 21
Getting your health care covered, cont.
require a disability claim, income and assets below a certain
level to qualify. Several states offer Medicaid to all childless
adults (AZ, DE, HI, MA, NY and VT), while several others
offer some benefits. States vary greatly in what they cover
and who qualifies.
MEDICARE (www.medicare.gov)
If you have held a job, youā€™ll likely qualify for Medicare.
However, you must wait 29 months after your disability
claim, during which you may be able to get your health care
through COBRA, Ryan White or Medicaid.
OTHER POSSIBLE SOURCES OF HELP
PATIENT ASSISTANCE PROGRAMS (PAPs)
PAPs are run by HIV drug makers to supply meds to
people who are under- or uninsured. They differ widely
in eligibility. These are not ideal for the long-term but can
help in the short-term or in an emergency.
VETERANS ADMINISTRATION (www.hiv.va.gov)
If youā€™re a veteran or family member, youā€™re eligible for care
through the VA. VA sites are only found in some areas and
vary in their ability to provide HIV care. As a veteran, you can
access Ryan White programs, but if your VA facility is acces-
sible and offers quality HIV care, it may be a good option.
HELPFUL RESOURCES
Welvista (access HIV meds for those on ADAP wait lists) www.welvista.org
Federal resource on health care www.healthcare.gov
Pre-existing Conditions Insurance Plans www.pcip.gov, www.pciplan.com
List of PAPs for HIV meds www.fairpricingcoalition.org
Social Security Administration www.socialsecurity.gov
HIV Health & Wellness: Considering treatment and your health care22
You will need to find a doctor whoā€™s able and willing to treat
HIV, ideally one who already has experience with HIV.
Depending on how and where you get health care, you may
not have many choices.
Experienced doctors usually keep up with recent develop-
ments in treating HIV. They also have a better sense of
preventive health care. If you can, itā€™s also important to find
other doctors like gynecologists, eye doctors and dentists
who have HIV experience.
Doctors with less or no HIV experience may need to
consult resources that can help them provide the best
medical care for you. Resources are available that can help
you and your doctor make informed decisions.
The WarmLine (National HIV/AIDS Cliniciansā€™ Consul-
tation Center) provides expert clinical advice to medical
professionals. Itā€™s available Mondayā€“Friday, 8amā€“8pm,
Eastern Time. (See below.)
Is your doctor experienced
in treating HIV?
HELPFUL RESOURCES
WarmLine 800-933-3413 (for doctors only),
www.nccc.ucsf.edu/about_nccc/warmline/
AIDS Education Training Centers www.aids-ed.org
Clinical Care Options www.clinicaloptions.com
GLMAā€™s Find a Provider www.glma.org, click FIND A PROVIDER
HIVMAā€™s Find a Provider www.hivma.org, click FIND AN HIV PROVIDER
AAHIVMā€™s Find a Provider www.aahivm.org, use REFERRALLINK at right
HIV Health & Wellness: Considering treatment and your health care 23
Important questionsImportant questions
FOR YOUR DOCTOR:
Do you start every
patient on treatment at
the same time, or on the
same regimen? Why or
why not?
Should I be concerned
about HIV meds inter-
acting with other drugs
or herbs that Iā€™m taking?
Should I be concerned
about drug resistance,
and how do I keep
ahead of it?
What tests or prescrip-
tions are covered by my
insurance (public or
private)?
How do blood tests
inform my decision to
start treatment?
What vaccines do you
recommend I get? Why?
What if Iā€™m not ready to
start treatment?
Are there are any other
tests that I should take
before starting an HIV
regimen?
FOR OTHERS:
Have you started on HIV
meds? Why or why not?
What was important
for you to understand
to help you make a
decision about starting
meds?
When did you know it
was the right time to
start?
What other ways do you
keep yourself healthy?
Do you know of support
groups or agencies that
help people talk about
these decisions?
How do you make sure
you take every dose of
your meds every day?
How did your blood
work inform your deci-
sion to start?
Did other things affect
your treatment decision?
What HIV treatment
information do you rely
on? Why?
HIV Health & Wellness: Considering treatment and your health care24
Checklist for getting started
I am (am not) ready to start taking HIV meds, and under-
stand the reasons why I want (donā€™t want) to start.
My CD4 count is _______.
The trend is stable, increasing, decreasing.
My viral load is _______.
The trend is stable; increasing; decreasing.
I have a good understanding of the risks and benefits of
starting treatment according to my individual needs.
I have thought about how HIV treatment may impact my life.
Iā€™ve considered the issues around taking HIV meds and oral
birth control, or HIV meds and pregnancy.
I have private or public insurance or another way to cover
the cost of my doctor visits, medicines and blood work.
I know where to go to get other types of support, like
mental health or housing services, that will help me stay
healthy.
I will ask how to properly take my medicines.
I understand how my doctor and I will check to see if my
regimen is working.
I know what side effects may give me the most problems, like
nausea or diarrhea, and which likely get better over time.
Iā€™m aware of what I can do to help avoid or lessen side effects.
If I want privacy when taking my meds, Iā€™ve thought about
how to ensure that.
If I have questions and my doctor is not available,
I can call _________________ or __________________.
273 Ninth Street
San Francisco, CA 94103
www.projectinform.org/HIVhealth/
To order copies: booklets@projectinform.org.
To give feedback: www.projectinform.org/HIVhealth/.
To get e-newsletter: www.projectinform.org/signup/.

More Related Content

What's hot

Anton Pozniak: "The Test and Treat Approach: Achieving 90-90-90"
Anton Pozniak: "The Test and Treat Approach: Achieving 90-90-90"Anton Pozniak: "The Test and Treat Approach: Achieving 90-90-90"
Anton Pozniak: "The Test and Treat Approach: Achieving 90-90-90"HopkinsCFAR
Ā 
Living With HIV
Living With HIVLiving With HIV
Living With HIVCollin Ang
Ā 
Approach to child with malnutrition
Approach to child with malnutrition Approach to child with malnutrition
Approach to child with malnutrition BISHAL SAPKOTA
Ā 
H I V C O M M O N S M Y T H S
H I V  C O M M O N S  M Y T H SH I V  C O M M O N S  M Y T H S
H I V C O M M O N S M Y T H Svictorserranov
Ā 
Junior paper final copy
Junior paper final copyJunior paper final copy
Junior paper final copyRasheadapratt
Ā 
H I V E D 8.03.09
H I V  E D 8.03.09H I V  E D 8.03.09
H I V E D 8.03.09Jason Leider
Ā 
Hfle presentation
Hfle presentationHfle presentation
Hfle presentationSashaine Mills
Ā 
August 2013 PLUS HIV Treatment
August 2013 PLUS HIV TreatmentAugust 2013 PLUS HIV Treatment
August 2013 PLUS HIV TreatmentPositive_Force
Ā 
HIV (Durgapur Steel Plant Hospital) 01 dec 09
HIV (Durgapur Steel Plant Hospital) 01 dec 09HIV (Durgapur Steel Plant Hospital) 01 dec 09
HIV (Durgapur Steel Plant Hospital) 01 dec 09Ratnadeep Ganguly
Ā 
Health
HealthHealth
HealthAlbert Mc
Ā 
AIDS in Pakistan
AIDS in PakistanAIDS in Pakistan
AIDS in PakistanTahmina Javed
Ā 
Multidrug-resistant Tuberculosis - What every patient should know...
Multidrug-resistant Tuberculosis - What every patient should know...Multidrug-resistant Tuberculosis - What every patient should know...
Multidrug-resistant Tuberculosis - What every patient should know...damienfoundation
Ā 
Reproductive Health Bill
Reproductive Health BillReproductive Health Bill
Reproductive Health Billallizalibu
Ā 
Oral PrEP E-learning: Discussion Session
Oral PrEP E-learning: Discussion SessionOral PrEP E-learning: Discussion Session
Oral PrEP E-learning: Discussion SessionJSI
Ā 
Changes of sexual practices of people living with hiv after initiation of ant...
Changes of sexual practices of people living with hiv after initiation of ant...Changes of sexual practices of people living with hiv after initiation of ant...
Changes of sexual practices of people living with hiv after initiation of ant...PinHealth
Ā 

What's hot (19)

Anton Pozniak: "The Test and Treat Approach: Achieving 90-90-90"
Anton Pozniak: "The Test and Treat Approach: Achieving 90-90-90"Anton Pozniak: "The Test and Treat Approach: Achieving 90-90-90"
Anton Pozniak: "The Test and Treat Approach: Achieving 90-90-90"
Ā 
Living With HIV
Living With HIVLiving With HIV
Living With HIV
Ā 
Paper
PaperPaper
Paper
Ā 
HIV PREVENTION
HIV PREVENTIONHIV PREVENTION
HIV PREVENTION
Ā 
Approach to child with malnutrition
Approach to child with malnutrition Approach to child with malnutrition
Approach to child with malnutrition
Ā 
H I V C O M M O N S M Y T H S
H I V  C O M M O N S  M Y T H SH I V  C O M M O N S  M Y T H S
H I V C O M M O N S M Y T H S
Ā 
Junior paper final copy
Junior paper final copyJunior paper final copy
Junior paper final copy
Ā 
H I V E D 8.03.09
H I V  E D 8.03.09H I V  E D 8.03.09
H I V E D 8.03.09
Ā 
Hfle presentation
Hfle presentationHfle presentation
Hfle presentation
Ā 
2017 aids day
2017 aids day2017 aids day
2017 aids day
Ā 
August 2013 PLUS HIV Treatment
August 2013 PLUS HIV TreatmentAugust 2013 PLUS HIV Treatment
August 2013 PLUS HIV Treatment
Ā 
HIV (Durgapur Steel Plant Hospital) 01 dec 09
HIV (Durgapur Steel Plant Hospital) 01 dec 09HIV (Durgapur Steel Plant Hospital) 01 dec 09
HIV (Durgapur Steel Plant Hospital) 01 dec 09
Ā 
Health
HealthHealth
Health
Ā 
AIDS in Pakistan
AIDS in PakistanAIDS in Pakistan
AIDS in Pakistan
Ā 
Hepatitis a
Hepatitis aHepatitis a
Hepatitis a
Ā 
Multidrug-resistant Tuberculosis - What every patient should know...
Multidrug-resistant Tuberculosis - What every patient should know...Multidrug-resistant Tuberculosis - What every patient should know...
Multidrug-resistant Tuberculosis - What every patient should know...
Ā 
Reproductive Health Bill
Reproductive Health BillReproductive Health Bill
Reproductive Health Bill
Ā 
Oral PrEP E-learning: Discussion Session
Oral PrEP E-learning: Discussion SessionOral PrEP E-learning: Discussion Session
Oral PrEP E-learning: Discussion Session
Ā 
Changes of sexual practices of people living with hiv after initiation of ant...
Changes of sexual practices of people living with hiv after initiation of ant...Changes of sexual practices of people living with hiv after initiation of ant...
Changes of sexual practices of people living with hiv after initiation of ant...
Ā 

Viewers also liked

Psych 1170, Gina Robinson
Psych 1170, Gina RobinsonPsych 1170, Gina Robinson
Psych 1170, Gina RobinsonGina_Rae
Ā 
10 acts to see at Seasons Festival 2015 | BeatRoute Magazine
10 acts to see at Seasons Festival 2015 | BeatRoute Magazine10 acts to see at Seasons Festival 2015 | BeatRoute Magazine
10 acts to see at Seasons Festival 2015 | BeatRoute MagazineMatthew Owchar
Ā 
2015 Fall Class Guide
2015 Fall Class Guide2015 Fall Class Guide
2015 Fall Class GuideLinda Parker
Ā 
List to Relieve Stress in the Office
List to Relieve Stress in the OfficeList to Relieve Stress in the Office
List to Relieve Stress in the OfficeAmerican Power and Gas
Ā 
WTM Intro to Tripwing
WTM Intro to TripwingWTM Intro to Tripwing
WTM Intro to TripwingTripwing
Ā 
N1怐ēŸ³å·ć€‘č—¤č°·å’Œå»£
N1怐ēŸ³å·ć€‘č—¤č°·å’Œå»£N1怐ēŸ³å·ć€‘č—¤č°·å’Œå»£
N1怐ēŸ³å·ć€‘č—¤č°·å’Œå»£nice-workcamp
Ā 
Š”ŠŗŠøŠ“ŠŗŠø Šø Š°ŠŗцŠøŠø Š² Š³ŠøŠæŠµŃ€Š¼Š°Ń€ŠŗŠµŃ‚Šµ ŠŠ°Ńˆ с 03 ŠæŠ¾ 16 Š½Š¾ŃŠ±Ń€Ń 2015Š³.
Š”ŠŗŠøŠ“ŠŗŠø Šø Š°ŠŗцŠøŠø Š² Š³ŠøŠæŠµŃ€Š¼Š°Ń€ŠŗŠµŃ‚Šµ ŠŠ°Ńˆ с 03 ŠæŠ¾ 16 Š½Š¾ŃŠ±Ń€Ń 2015Š³.Š”ŠŗŠøŠ“ŠŗŠø Šø Š°ŠŗцŠøŠø Š² Š³ŠøŠæŠµŃ€Š¼Š°Ń€ŠŗŠµŃ‚Šµ ŠŠ°Ńˆ с 03 ŠæŠ¾ 16 Š½Š¾ŃŠ±Ń€Ń 2015Š³.
Š”ŠŗŠøŠ“ŠŗŠø Šø Š°ŠŗцŠøŠø Š² Š³ŠøŠæŠµŃ€Š¼Š°Ń€ŠŗŠµŃ‚Šµ ŠŠ°Ńˆ с 03 ŠæŠ¾ 16 Š½Š¾ŃŠ±Ń€Ń 2015Š³.ŠœŠøхŠ°ŠøŠ» Š‘ычŠŗŠ¾Š²
Ā 
Vi du 1 mong nong 2 d- C2Cstudy
Vi du  1 mong nong 2 d- C2CstudyVi du  1 mong nong 2 d- C2Cstudy
Vi du 1 mong nong 2 d- C2CstudyThien Nguyen
Ā 
Exmovere Brainfax Saliva Testing Concept by David Bychkov, PhD
Exmovere Brainfax Saliva Testing Concept by David Bychkov, PhDExmovere Brainfax Saliva Testing Concept by David Bychkov, PhD
Exmovere Brainfax Saliva Testing Concept by David Bychkov, PhDDavid Bychkov, PhD
Ā 
The art of copying
The art of copyingThe art of copying
The art of copyingRafael_fiori
Ā 

Viewers also liked (14)

Psych 1170, Gina Robinson
Psych 1170, Gina RobinsonPsych 1170, Gina Robinson
Psych 1170, Gina Robinson
Ā 
10 acts to see at Seasons Festival 2015 | BeatRoute Magazine
10 acts to see at Seasons Festival 2015 | BeatRoute Magazine10 acts to see at Seasons Festival 2015 | BeatRoute Magazine
10 acts to see at Seasons Festival 2015 | BeatRoute Magazine
Ā 
2015 Fall Class Guide
2015 Fall Class Guide2015 Fall Class Guide
2015 Fall Class Guide
Ā 
List to Relieve Stress in the Office
List to Relieve Stress in the OfficeList to Relieve Stress in the Office
List to Relieve Stress in the Office
Ā 
WTM Intro to Tripwing
WTM Intro to TripwingWTM Intro to Tripwing
WTM Intro to Tripwing
Ā 
N1怐ēŸ³å·ć€‘č—¤č°·å’Œå»£
N1怐ēŸ³å·ć€‘č—¤č°·å’Œå»£N1怐ēŸ³å·ć€‘č—¤č°·å’Œå»£
N1怐ēŸ³å·ć€‘č—¤č°·å’Œå»£
Ā 
Exposision 1
Exposision 1Exposision 1
Exposision 1
Ā 
Ur-Energy November 2015 Corporate Presentation
Ur-Energy November 2015 Corporate PresentationUr-Energy November 2015 Corporate Presentation
Ur-Energy November 2015 Corporate Presentation
Ā 
RESEARCH PAPER-2
RESEARCH PAPER-2RESEARCH PAPER-2
RESEARCH PAPER-2
Ā 
Š”ŠŗŠøŠ“ŠŗŠø Šø Š°ŠŗцŠøŠø Š² Š³ŠøŠæŠµŃ€Š¼Š°Ń€ŠŗŠµŃ‚Šµ ŠŠ°Ńˆ с 03 ŠæŠ¾ 16 Š½Š¾ŃŠ±Ń€Ń 2015Š³.
Š”ŠŗŠøŠ“ŠŗŠø Šø Š°ŠŗцŠøŠø Š² Š³ŠøŠæŠµŃ€Š¼Š°Ń€ŠŗŠµŃ‚Šµ ŠŠ°Ńˆ с 03 ŠæŠ¾ 16 Š½Š¾ŃŠ±Ń€Ń 2015Š³.Š”ŠŗŠøŠ“ŠŗŠø Šø Š°ŠŗцŠøŠø Š² Š³ŠøŠæŠµŃ€Š¼Š°Ń€ŠŗŠµŃ‚Šµ ŠŠ°Ńˆ с 03 ŠæŠ¾ 16 Š½Š¾ŃŠ±Ń€Ń 2015Š³.
Š”ŠŗŠøŠ“ŠŗŠø Šø Š°ŠŗцŠøŠø Š² Š³ŠøŠæŠµŃ€Š¼Š°Ń€ŠŗŠµŃ‚Šµ ŠŠ°Ńˆ с 03 ŠæŠ¾ 16 Š½Š¾ŃŠ±Ń€Ń 2015Š³.
Ā 
Vi du 1 mong nong 2 d- C2Cstudy
Vi du  1 mong nong 2 d- C2CstudyVi du  1 mong nong 2 d- C2Cstudy
Vi du 1 mong nong 2 d- C2Cstudy
Ā 
Firmas
FirmasFirmas
Firmas
Ā 
Exmovere Brainfax Saliva Testing Concept by David Bychkov, PhD
Exmovere Brainfax Saliva Testing Concept by David Bychkov, PhDExmovere Brainfax Saliva Testing Concept by David Bychkov, PhD
Exmovere Brainfax Saliva Testing Concept by David Bychkov, PhD
Ā 
The art of copying
The art of copyingThe art of copying
The art of copying
Ā 

Similar to Consideringtreatmentandyourhealthcare 130129172100-phpapp01

Considering Treatment and Your Health Care (Additional PLUS Reading Materials)
Considering Treatment and Your Health Care (Additional PLUS Reading Materials)Considering Treatment and Your Health Care (Additional PLUS Reading Materials)
Considering Treatment and Your Health Care (Additional PLUS Reading Materials)Positive_Force
Ā 
Now That Youā€™ve Started Treatment (Additional PLUS Reading Materials)
Now That Youā€™ve Started Treatment (Additional PLUS Reading Materials)Now That Youā€™ve Started Treatment (Additional PLUS Reading Materials)
Now That Youā€™ve Started Treatment (Additional PLUS Reading Materials)Positive_Force
Ā 
Now that you've started treatment
Now that you've started treatmentNow that you've started treatment
Now that you've started treatmentPositive Life
Ā 
Hiv and its treatment
Hiv and its treatmentHiv and its treatment
Hiv and its treatmentMicrobiology
Ā 
Hiv and its treatment
Hiv and its treatmentHiv and its treatment
Hiv and its treatmentMicrobiology
Ā 
Practical Guide to HIV Treatment
Practical Guide to HIV TreatmentPractical Guide to HIV Treatment
Practical Guide to HIV TreatmentDerek Thaczuk
Ā 
HIV AIDS awareness - Dr Venkatesh Karthikeyan
HIV AIDS awareness - Dr Venkatesh KarthikeyanHIV AIDS awareness - Dr Venkatesh Karthikeyan
HIV AIDS awareness - Dr Venkatesh KarthikeyanDr Venkatesh Karthikeyan
Ā 
Adult Vaccines: Give Your Health a Shot
Adult Vaccines: Give Your Health a ShotAdult Vaccines: Give Your Health a Shot
Adult Vaccines: Give Your Health a ShotTmbMedical
Ā 
Human Immunodeficiency Virus (HIV)
Human Immunodeficiency Virus (HIV)Human Immunodeficiency Virus (HIV)
Human Immunodeficiency Virus (HIV)AdetoyiKolawole
Ā 
Check out the Benefits of Medical Marijuana for HIV/AIDS
Check out the Benefits of Medical Marijuana for HIV/AIDSCheck out the Benefits of Medical Marijuana for HIV/AIDS
Check out the Benefits of Medical Marijuana for HIV/AIDSMMJ Card Iowa
Ā 
2 hiv a communicable disease
2 hiv  a communicable disease2 hiv  a communicable disease
2 hiv a communicable diseaseMahendra Poudel
Ā 
Voluntary Counselling and Testing.pptx
Voluntary Counselling and Testing.pptxVoluntary Counselling and Testing.pptx
Voluntary Counselling and Testing.pptxCHRIS ADREIN KANAKUZE
Ā 
Group-3-HIV-AIDS-pptx.pptx
Group-3-HIV-AIDS-pptx.pptxGroup-3-HIV-AIDS-pptx.pptx
Group-3-HIV-AIDS-pptx.pptxJonathancagasan1
Ā 
HAP 752 Semester Long Project Write-Up Koyin Aladesuru Linkedin
HAP 752 Semester Long Project Write-Up Koyin Aladesuru LinkedinHAP 752 Semester Long Project Write-Up Koyin Aladesuru Linkedin
HAP 752 Semester Long Project Write-Up Koyin Aladesuru LinkedinKoyin Aladesuru
Ā 
COUNSELLING FOR AIDS PATIENTS.pptx
COUNSELLING  FOR AIDS  PATIENTS.pptxCOUNSELLING  FOR AIDS  PATIENTS.pptx
COUNSELLING FOR AIDS PATIENTS.pptxANCHAL176688
Ā 
reproductive health.pptx
reproductive health.pptxreproductive health.pptx
reproductive health.pptxMercyPadua1
Ā 

Similar to Consideringtreatmentandyourhealthcare 130129172100-phpapp01 (20)

Considering Treatment and Your Health Care (Additional PLUS Reading Materials)
Considering Treatment and Your Health Care (Additional PLUS Reading Materials)Considering Treatment and Your Health Care (Additional PLUS Reading Materials)
Considering Treatment and Your Health Care (Additional PLUS Reading Materials)
Ā 
Now That Youā€™ve Started Treatment (Additional PLUS Reading Materials)
Now That Youā€™ve Started Treatment (Additional PLUS Reading Materials)Now That Youā€™ve Started Treatment (Additional PLUS Reading Materials)
Now That Youā€™ve Started Treatment (Additional PLUS Reading Materials)
Ā 
Now that you've started treatment
Now that you've started treatmentNow that you've started treatment
Now that you've started treatment
Ā 
Hiv and its treatment
Hiv and its treatmentHiv and its treatment
Hiv and its treatment
Ā 
Hiv and its treatment
Hiv and its treatmentHiv and its treatment
Hiv and its treatment
Ā 
Practical Guide to HIV Treatment
Practical Guide to HIV TreatmentPractical Guide to HIV Treatment
Practical Guide to HIV Treatment
Ā 
HIV AIDS awareness - Dr Venkatesh Karthikeyan
HIV AIDS awareness - Dr Venkatesh KarthikeyanHIV AIDS awareness - Dr Venkatesh Karthikeyan
HIV AIDS awareness - Dr Venkatesh Karthikeyan
Ā 
Adult Vaccines: Give Your Health a Shot
Adult Vaccines: Give Your Health a ShotAdult Vaccines: Give Your Health a Shot
Adult Vaccines: Give Your Health a Shot
Ā 
Human Immunodeficiency Virus (HIV)
Human Immunodeficiency Virus (HIV)Human Immunodeficiency Virus (HIV)
Human Immunodeficiency Virus (HIV)
Ā 
Check out the Benefits of Medical Marijuana for HIV/AIDS
Check out the Benefits of Medical Marijuana for HIV/AIDSCheck out the Benefits of Medical Marijuana for HIV/AIDS
Check out the Benefits of Medical Marijuana for HIV/AIDS
Ā 
2 hiv a communicable disease
2 hiv  a communicable disease2 hiv  a communicable disease
2 hiv a communicable disease
Ā 
Voluntary Counselling and Testing.pptx
Voluntary Counselling and Testing.pptxVoluntary Counselling and Testing.pptx
Voluntary Counselling and Testing.pptx
Ā 
Group-3-HIV-AIDS-pptx.pptx
Group-3-HIV-AIDS-pptx.pptxGroup-3-HIV-AIDS-pptx.pptx
Group-3-HIV-AIDS-pptx.pptx
Ā 
HIV Aids.pptx
HIV Aids.pptxHIV Aids.pptx
HIV Aids.pptx
Ā 
HAP 752 Semester Long Project Write-Up Koyin Aladesuru Linkedin
HAP 752 Semester Long Project Write-Up Koyin Aladesuru LinkedinHAP 752 Semester Long Project Write-Up Koyin Aladesuru Linkedin
HAP 752 Semester Long Project Write-Up Koyin Aladesuru Linkedin
Ā 
COUNSELLING FOR AIDS PATIENTS.pptx
COUNSELLING  FOR AIDS  PATIENTS.pptxCOUNSELLING  FOR AIDS  PATIENTS.pptx
COUNSELLING FOR AIDS PATIENTS.pptx
Ā 
Emerging issues on hiv & aids
Emerging issues on hiv & aidsEmerging issues on hiv & aids
Emerging issues on hiv & aids
Ā 
reproductive health.pptx
reproductive health.pptxreproductive health.pptx
reproductive health.pptx
Ā 
Hiv and Aids.pptx
Hiv and Aids.pptxHiv and Aids.pptx
Hiv and Aids.pptx
Ā 
You Are Not Alone
You Are Not AloneYou Are Not Alone
You Are Not Alone
Ā 

More from Positive Life

Living In An Era of HIV
Living In An Era of HIVLiving In An Era of HIV
Living In An Era of HIVPositive Life
Ā 
Herbs, supplimenats and hiv
Herbs, supplimenats and hivHerbs, supplimenats and hiv
Herbs, supplimenats and hivPositive Life
Ā 
Usiing dietary supplements wisely
Usiing dietary supplements wiselyUsiing dietary supplements wisely
Usiing dietary supplements wiselyPositive Life
Ā 
Making decisions about therapies
Making decisions about therapiesMaking decisions about therapies
Making decisions about therapiesPositive Life
Ā 
Complimentry and aternative medicine continued
Complimentry and aternative medicine continuedComplimentry and aternative medicine continued
Complimentry and aternative medicine continuedPositive Life
Ā 
Complimentary and alternative medicine
Complimentary and alternative medicineComplimentary and alternative medicine
Complimentary and alternative medicinePositive Life
Ā 
Dealing with drug side effects
Dealing with drug side effectsDealing with drug side effects
Dealing with drug side effectsPositive Life
Ā 
Building a patient:doctor relationship
Building a patient:doctor relationshipBuilding a patient:doctor relationship
Building a patient:doctor relationshipPositive Life
Ā 
Usiing dietary supplements wisely
Usiing dietary supplements wiselyUsiing dietary supplements wisely
Usiing dietary supplements wiselyPositive Life
Ā 
Whats New Hiv Treatment Guidlines
Whats New   Hiv Treatment GuidlinesWhats New   Hiv Treatment Guidlines
Whats New Hiv Treatment GuidlinesPositive Life
Ā 
Std2011plus2 111204122105 Phpapp02
Std2011plus2 111204122105 Phpapp02Std2011plus2 111204122105 Phpapp02
Std2011plus2 111204122105 Phpapp02Positive Life
Ā 
Winter Nutrition
Winter NutritionWinter Nutrition
Winter NutritionPositive Life
Ā 
Makingdecisionsabouttherapies 110914180647 Phpapp02
Makingdecisionsabouttherapies 110914180647 Phpapp02Makingdecisionsabouttherapies 110914180647 Phpapp02
Makingdecisionsabouttherapies 110914180647 Phpapp02Positive Life
Ā 
Hivtreatmentdecember2011 111204184012 Phpapp02
Hivtreatmentdecember2011 111204184012 Phpapp02Hivtreatmentdecember2011 111204184012 Phpapp02
Hivtreatmentdecember2011 111204184012 Phpapp02Positive Life
Ā 
Dealingwithsideeffects 110914180652 Phpapp02
Dealingwithsideeffects 110914180652 Phpapp02Dealingwithsideeffects 110914180652 Phpapp02
Dealingwithsideeffects 110914180652 Phpapp02Positive Life
Ā 
Advocacy And Hiv 1
Advocacy And Hiv 1Advocacy And Hiv 1
Advocacy And Hiv 1Positive Life
Ā 

More from Positive Life (20)

Living In An Era of HIV
Living In An Era of HIVLiving In An Era of HIV
Living In An Era of HIV
Ā 
Herbs, supplimenats and hiv
Herbs, supplimenats and hivHerbs, supplimenats and hiv
Herbs, supplimenats and hiv
Ā 
Smart eating
Smart eatingSmart eating
Smart eating
Ā 
Eat real food
Eat real foodEat real food
Eat real food
Ā 
Usiing dietary supplements wisely
Usiing dietary supplements wiselyUsiing dietary supplements wisely
Usiing dietary supplements wisely
Ā 
Making decisions about therapies
Making decisions about therapiesMaking decisions about therapies
Making decisions about therapies
Ā 
Complimentry and aternative medicine continued
Complimentry and aternative medicine continuedComplimentry and aternative medicine continued
Complimentry and aternative medicine continued
Ā 
Complimentary and alternative medicine
Complimentary and alternative medicineComplimentary and alternative medicine
Complimentary and alternative medicine
Ā 
Dealing with drug side effects
Dealing with drug side effectsDealing with drug side effects
Dealing with drug side effects
Ā 
Building a patient:doctor relationship
Building a patient:doctor relationshipBuilding a patient:doctor relationship
Building a patient:doctor relationship
Ā 
Adherence
AdherenceAdherence
Adherence
Ā 
Usiing dietary supplements wisely
Usiing dietary supplements wiselyUsiing dietary supplements wisely
Usiing dietary supplements wisely
Ā 
Whats New Hiv Treatment Guidlines
Whats New   Hiv Treatment GuidlinesWhats New   Hiv Treatment Guidlines
Whats New Hiv Treatment Guidlines
Ā 
Std2011plus2 111204122105 Phpapp02
Std2011plus2 111204122105 Phpapp02Std2011plus2 111204122105 Phpapp02
Std2011plus2 111204122105 Phpapp02
Ā 
Winter Nutrition
Winter NutritionWinter Nutrition
Winter Nutrition
Ā 
Makingdecisionsabouttherapies 110914180647 Phpapp02
Makingdecisionsabouttherapies 110914180647 Phpapp02Makingdecisionsabouttherapies 110914180647 Phpapp02
Makingdecisionsabouttherapies 110914180647 Phpapp02
Ā 
Hivtreatmentdecember2011 111204184012 Phpapp02
Hivtreatmentdecember2011 111204184012 Phpapp02Hivtreatmentdecember2011 111204184012 Phpapp02
Hivtreatmentdecember2011 111204184012 Phpapp02
Ā 
Hiv Lifecycle
Hiv LifecycleHiv Lifecycle
Hiv Lifecycle
Ā 
Dealingwithsideeffects 110914180652 Phpapp02
Dealingwithsideeffects 110914180652 Phpapp02Dealingwithsideeffects 110914180652 Phpapp02
Dealingwithsideeffects 110914180652 Phpapp02
Ā 
Advocacy And Hiv 1
Advocacy And Hiv 1Advocacy And Hiv 1
Advocacy And Hiv 1
Ā 

Recently uploaded

Call Girls in Lucknow Just Call šŸ‘‰šŸ‘‰7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call šŸ‘‰šŸ‘‰7877925207 Top Class Call Girl Service Avai...Call Girls in Lucknow Just Call šŸ‘‰šŸ‘‰7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call šŸ‘‰šŸ‘‰7877925207 Top Class Call Girl Service Avai...adilkhan87451
Ā 
Top Rated Call Girls Kerala ā˜Ž 8250092165šŸ‘„ Delivery in 20 Mins Near Me
Top Rated Call Girls Kerala ā˜Ž 8250092165šŸ‘„ Delivery in 20 Mins Near MeTop Rated Call Girls Kerala ā˜Ž 8250092165šŸ‘„ Delivery in 20 Mins Near Me
Top Rated Call Girls Kerala ā˜Ž 8250092165šŸ‘„ Delivery in 20 Mins Near Mechennailover
Ā 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ā£ 8445551418 ā£ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ā£ 8445551418 ā£ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ā£ 8445551418 ā£ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ā£ 8445551418 ā£ Elite Models & Ce...parulsinha
Ā 
Independent Call Girls In Jaipur { 8445551418 } āœ” ANIKA MEHTA āœ” Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } āœ” ANIKA MEHTA āœ” Get High Prof...Independent Call Girls In Jaipur { 8445551418 } āœ” ANIKA MEHTA āœ” Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } āœ” ANIKA MEHTA āœ” Get High Prof...parulsinha
Ā 
Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510Vipesco
Ā 
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...karishmasinghjnh
Ā 
Call Girls Mysore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Mysore Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Mysore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Mysore Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
Ā 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...chennailover
Ā 
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappMost Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappInaaya Sharma
Ā 
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
Ā 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ā‚¹5000 To 25K With AC Room šŸ’ššŸ˜‹
VIP Hyderabad Call Girls Bahadurpally 7877925207 ā‚¹5000 To 25K With AC Room šŸ’ššŸ˜‹VIP Hyderabad Call Girls Bahadurpally 7877925207 ā‚¹5000 To 25K With AC Room šŸ’ššŸ˜‹
VIP Hyderabad Call Girls Bahadurpally 7877925207 ā‚¹5000 To 25K With AC Room šŸ’ššŸ˜‹TANUJA PANDEY
Ā 
šŸ’šCall Girls In Amritsar šŸ’ÆAnvi šŸ“²šŸ”8725944379šŸ”Amritsar Call Girl NošŸ’°Advance Cash...
šŸ’šCall Girls In Amritsar šŸ’ÆAnvi šŸ“²šŸ”8725944379šŸ”Amritsar Call Girl NošŸ’°Advance Cash...šŸ’šCall Girls In Amritsar šŸ’ÆAnvi šŸ“²šŸ”8725944379šŸ”Amritsar Call Girl NošŸ’°Advance Cash...
šŸ’šCall Girls In Amritsar šŸ’ÆAnvi šŸ“²šŸ”8725944379šŸ”Amritsar Call Girl NošŸ’°Advance Cash...Sheetaleventcompany
Ā 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...tanya dube
Ā 
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
Ā 
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...chennailover
Ā 
Top Rated Hyderabad Call Girls Erragadda āŸŸ 9332606886 āŸŸ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda āŸŸ 9332606886 āŸŸ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda āŸŸ 9332606886 āŸŸ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda āŸŸ 9332606886 āŸŸ Call Me For Genuine ...chandars293
Ā 
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service AvailableGENUINE ESCORT AGENCY
Ā 
Russian Call Girls Service Jaipur {8445551418} ā¤ļøPALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ā¤ļøPALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ā¤ļøPALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ā¤ļøPALLAVI VIP Jaipur Call Gir...parulsinha
Ā 
Call Girls Service Jaipur {9521753030} ā¤ļøVVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ā¤ļøVVIP RIDDHI Call Girl in Jaipur Raja...Call Girls Service Jaipur {9521753030} ā¤ļøVVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ā¤ļøVVIP RIDDHI Call Girl in Jaipur Raja...Sheetaleventcompany
Ā 

Recently uploaded (20)

Call Girls in Lucknow Just Call šŸ‘‰šŸ‘‰7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call šŸ‘‰šŸ‘‰7877925207 Top Class Call Girl Service Avai...Call Girls in Lucknow Just Call šŸ‘‰šŸ‘‰7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call šŸ‘‰šŸ‘‰7877925207 Top Class Call Girl Service Avai...
Ā 
Top Rated Call Girls Kerala ā˜Ž 8250092165šŸ‘„ Delivery in 20 Mins Near Me
Top Rated Call Girls Kerala ā˜Ž 8250092165šŸ‘„ Delivery in 20 Mins Near MeTop Rated Call Girls Kerala ā˜Ž 8250092165šŸ‘„ Delivery in 20 Mins Near Me
Top Rated Call Girls Kerala ā˜Ž 8250092165šŸ‘„ Delivery in 20 Mins Near Me
Ā 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ā£ 8445551418 ā£ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ā£ 8445551418 ā£ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ā£ 8445551418 ā£ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ā£ 8445551418 ā£ Elite Models & Ce...
Ā 
Independent Call Girls In Jaipur { 8445551418 } āœ” ANIKA MEHTA āœ” Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } āœ” ANIKA MEHTA āœ” Get High Prof...Independent Call Girls In Jaipur { 8445551418 } āœ” ANIKA MEHTA āœ” Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } āœ” ANIKA MEHTA āœ” Get High Prof...
Ā 
Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510
Ā 
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Ā 
Call Girls Mysore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Mysore Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Mysore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Mysore Just Call 8250077686 Top Class Call Girl Service Available
Ā 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Ā 
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappMost Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Ā 
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Ā 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ā‚¹5000 To 25K With AC Room šŸ’ššŸ˜‹
VIP Hyderabad Call Girls Bahadurpally 7877925207 ā‚¹5000 To 25K With AC Room šŸ’ššŸ˜‹VIP Hyderabad Call Girls Bahadurpally 7877925207 ā‚¹5000 To 25K With AC Room šŸ’ššŸ˜‹
VIP Hyderabad Call Girls Bahadurpally 7877925207 ā‚¹5000 To 25K With AC Room šŸ’ššŸ˜‹
Ā 
šŸ’šCall Girls In Amritsar šŸ’ÆAnvi šŸ“²šŸ”8725944379šŸ”Amritsar Call Girl NošŸ’°Advance Cash...
šŸ’šCall Girls In Amritsar šŸ’ÆAnvi šŸ“²šŸ”8725944379šŸ”Amritsar Call Girl NošŸ’°Advance Cash...šŸ’šCall Girls In Amritsar šŸ’ÆAnvi šŸ“²šŸ”8725944379šŸ”Amritsar Call Girl NošŸ’°Advance Cash...
šŸ’šCall Girls In Amritsar šŸ’ÆAnvi šŸ“²šŸ”8725944379šŸ”Amritsar Call Girl NošŸ’°Advance Cash...
Ā 
šŸŒ¹Attapurā¬…ļø Vip Call Girls Hyderabad šŸ“±9352852248 Book Well Trand Call Girls In...
šŸŒ¹Attapurā¬…ļø Vip Call Girls Hyderabad šŸ“±9352852248 Book Well Trand Call Girls In...šŸŒ¹Attapurā¬…ļø Vip Call Girls Hyderabad šŸ“±9352852248 Book Well Trand Call Girls In...
šŸŒ¹Attapurā¬…ļø Vip Call Girls Hyderabad šŸ“±9352852248 Book Well Trand Call Girls In...
Ā 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Ā 
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Ā 
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Ā 
Top Rated Hyderabad Call Girls Erragadda āŸŸ 9332606886 āŸŸ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda āŸŸ 9332606886 āŸŸ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda āŸŸ 9332606886 āŸŸ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda āŸŸ 9332606886 āŸŸ Call Me For Genuine ...
Ā 
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Ā 
Russian Call Girls Service Jaipur {8445551418} ā¤ļøPALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ā¤ļøPALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ā¤ļøPALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ā¤ļøPALLAVI VIP Jaipur Call Gir...
Ā 
Call Girls Service Jaipur {9521753030} ā¤ļøVVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ā¤ļøVVIP RIDDHI Call Girl in Jaipur Raja...Call Girls Service Jaipur {9521753030} ā¤ļøVVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ā¤ļøVVIP RIDDHI Call Girl in Jaipur Raja...
Ā 

Consideringtreatmentandyourhealthcare 130129172100-phpapp01

  • 1. BOOKLET 2 OF 3 JANUARY 2013 Considering treatment and your health care your life matters HIV HEALTH & WELLNESS
  • 2.
  • 3. Table of contents Using this booklet ... 2 How is today different from earlier in the epidemic? 3 KNOWLEDGE: Understanding the details of treatment Why take HIV medications? 4ā€“5 Choosing the best time to start 6ā€“7 When to start: CD4 count ranges 8 Classes of HIV meds 9 Recommended regimens for first line treatment 10 A few things about your first regimen 11 Understanding test results 12 Resistance testing before starting 13 HEALTH: Your ability to start and maintain Women and HIV infection 14ā€“15 Are you ready to start? 16 Side effects from HIV meds 17 Drug interactions 18 SELF-ADVOCACY: Getting ready to start Getting your health care covered 19ā€“21 Is your doctor experienced in treating HIV? 22 Important questions to ask others 2 RESOURCES: Checklist for getting started 24 HIV Health & Wellness: Considering treatment and your health care 1
  • 4. Using this booklet ... The main focus of this booklet is to get you thinking about HIV and your health. Because treating HIV can be complex and because only you can take the medicines your body needs, your ability to commit to the meds are a critical part of your health decisions. Getting the earliest treatment is generally recommended for most illnesses. HIV may not be any different; except that once itā€™s started, treatment is for life. On one hand, deciding the best time to start HIV meds is a matter of personal choice. On the other, study results increasingly lean toward starting earlier. Some experts believe that starting meds is appropriate immediately after finding out your diagnosis. Waiting might allow HIV to progress further and do more damage to your immune system and to other body systems and organs such as your heart, blood vessels and kidneys. At a minimum, most doctors would agree that itā€™s neces- sary to start meds when HIV symptoms are present, your CD4 count is falling, or your viral load is high and rising. HELPFUL RESOURCES Just Diagnosed Resource Center www.thebody.com/content/art49985.html HIV Health & Wellness: Considering treatment and your health care2
  • 5. HIV Health & Wellness: Considering treatment and your health care 3 How is today different from earlier in the epidemic? Treating HIV is very different today than what it was earlier in the epi- demic. People are now healthier and living longer on HIV meds, and many can start with a full regimen of just one or two pills taken once or twice a day. There are fewer food restrictions, and drugs are generally easier to take and tolerate. Perhaps some of the things you believe about todayā€™s medicines are not ā€” or are no longer ā€” true. Concerns still linger in the community about severe side effects and how someone might look after being on meds for awhile. Newer regimens generally have fewer and more manage- able side effects. The drugs that caused the most problems are rarely used for people starting treatment in the US. Over the years, public health care programs as well as private health insurance have greatly improved their HIV care, allowing more people to find and pay for stable medi- cal care. The medical community also has a great deal more experience treating HIV today.
  • 6. Although most people donā€™t have outward symptoms of HIV for many years without being on treatment, itā€™s extremely rare that the immune system can fully sup- press HIV on its own. The longer you have untreated HIV the more damage it can do, making you more susceptible to infections and other health problems. IMPROVING QUALITY OF LIFE Being on HIV treatment should interfere as little as possible with your quality of life. It should be easy enough to use so you can take every dose as prescribed. For most people, itā€™s possible to find a regimen that works well with mini- mal side effects or drug interactions. If you cannot tolerate a drug or the regimen isnā€™t working for you, itā€™s possible to switch to other options. IMPROVING IMMUNE FUNCTION Taking HIV treatment normally produces a higher CD4 count. Some people experience a rapid rise in their CD4s after starting treatment, but for others the increase may take more time. This is especially true if you wait to start treatment until your CD4 counts are very low, such as below 100. Why take HIV medications? HIV Health & Wellness: Considering treatment and your health care4
  • 7. HIV Health & Wellness: Considering treatment and your health care 5 REDUCING VIRAL LOAD HIV treatment makes it easier for the immune system to control HIV. The goal is to keep HIV levels as low as possible for as long as possible, preferably below 50 copies (called undetectable). The minimum change that shows treatment is working is lowering your virus level by 90%, or a 1 log decrease (such as 10,000 down to 1,000). REDUCING DRUG RESISTANCE When HIV is fully suppressed by HIV meds, itā€™s less likely to change and become resistant to the drugs. Taking every dose as prescribed and staying undetect- able can help prevent resistance. Most commonly used HIV meds are so good now that theyā€™re able to overcome drug resistance for many years even with one or two doses missed every once in a while. HELPING PREVENT TRANSMISSION People who take HIV meds and stay undetectable are less likely to transmit HIV. However, even with good adherence to an HIV regimen, thereā€™s still some risk in transmitting HIV ā€” for example, active sexually transmitted diseases (herpes, syphilis, etc.) can increase the risk. Itā€™s important to continue engaging in safer sex.
  • 8. HIV Health & Wellness: Considering treatment and your health care6 The following factors can help you and your provider choose the best time to start treatment. YOUR CD4 COUNT TREND A trend is when you look at two or more CD4 count results to see how much they change. Over time, falling CD4s indicate declining immune health. A loss of 100 CD4s or more each year shows a weakening immune system. Donā€™t panic about a single lower test result, but consult with your doctor and consider another test to determine your trend. (Read more on page 8.) YOUR VIRAL LOAD TREND Increasing HIV levels over time indicate that the virus is reproducing and can infect more CD4s. Again, the trend is important: consider two or more test results to inform a treatment decision. Experts generally agree that viral load rising above 100,000 is a sign to start. Choosing the best time to start
  • 9. HIV Health & Wellness: Considering treatment and your health care 7 YOUR GENERAL HEALTH If your health is good and stable, then starting treat- ment right away may not be necessary. But if you have some symptoms of HIV disease, despite a good CD4 count, starting is usually the right decision. On the other hand, if you have an illness that may make it difficult to take HIV meds, it may be better to wait until that illness has resolved. Your doctor can help you make this decision. ARE YOU READY TO START? You should begin treatment when you feel youā€™re ready, but you shouldnā€™t put it off until all your fear is gone. Being ready includes being emotionally ready to com- mit over the long-term, as well as being able to take pills every day, manage possible side effects, and make sure you have ongoing health care. It might also mean dealing first with other issues such as finding stable housing or mental health or substance use services. THESE CONDITIONS INCREASE THE URGENCY TO START:
  • 10. HIV Health & Wellness: Considering treatment and your health care8 STARTING TREATMENT BETWEEN 0ā€“350 CD4 CELLS Waiting to start until a CD4 count drops below 350 puts you at much higher risk of developing many health problems. These can include conditions related to HIV (pneumonia, certain cancers, etc.) and other conditions (heart attacks, kidney disease, etc.). Almost all doctors would agree that people with low CD4 counts should start treatment as soon as possible. STARTING TREATMENT BETWEEN 350ā€“500 CD4 CELLS The risk of getting sick isnā€™t quite as high in this range. Fewer studies confirm the benefits of starting in this range compared to lower CD4s. For this reason, you may have more time to get ready to start. However, itā€™s important to under- stand that some studies suggest your risk of getting sick is higher if you donā€™t start in this range. Longer-term damage to your body is occurring as long as HIV is not kept low. STARTING TREATMENT ABOVE 500 CD4 CELLS A couple of studies show a lower risk for getting sick in people who start this early. Many other studies show that early damage to your immune system and other parts of the body happen when HIV isnā€™t well controlled ā€” no mat- ter the CD4 count. As well, people who are on treatment with undetectable HIV are much less likely to pass on HIV to their sex partners. However, even though the risk of side effects is much lower with modern treatment, taking meds longer could increase your chance of developing certain side effects. Itā€™s reasonable for someone to start above 500, but the pros and cons should be carefully considered. When to start: CD4 count ranges
  • 11. HIV Health & Wellness: Considering treatment and your health care 9 Classes of HIV meds Your first regimen will probably include three drugs from two different classes. These classes work against different steps in the life cycle of HIV. Using at least two classes to- gether provides better and longer-lasting health. Below is the current list of HIV meds, organized by class and then listed by brand name, generic name and year of FDA approval. Some drugs are no longer used or not used often in the US, while others are used only in special situations. NNRTIs (non-nucleoside reverse transcriptase inhibitors) Edurant (RPV, rilpivirine, 2011) Intelence (etravirine, 2008) Rescriptor (delavirdine, 1997) Sustiva (EFV, efavirenz, 1998) Viramune (nevirapine, 1996) ENTRY INHIBITORS Fuzeon (T20, enfuvirtide, injectable, 2003) Selzentry (maraviroc, 2007 FIXED DOSE COMBINATIONS Atripla (TDF+FTC+EFV, 2006) Combivir (AZT+3TC, 1997) Complera (RPV+TDF+FTC,2011) Epzicom (3TC+ABV, 2004) Stribild (ELV+TDF+FTC, 2012) Trizivir (AZT+3TC+ABV, 2000) Truvada (FTC+TDF, 2004) NRTIs (nucleoside/nucleotide reverse transcriptase inhibitors) Emtriva (FTC, emtricitabine, 2003) Epivir (3TC, lamivudine, 1995) Retrovir (AZT, zidovudine, 1987) Videx EC (ddI, didanosine, 2004) Viread (TDF, tenofovir, 2001) Zerit (d4T, stavudine, 1994) Ziagen (ABV, abacavir, 1998) PIs (protease inhibitors) Aptivus (tipranavir, 2005) Crixivan (indinavir, 1996) Invirase (saquinavir, 2003) Kaletra (lopinavir/r, 2000) Lexiva (fosamprenavir, 2003) Norvir (ritonavir, 1996) Prezista (darunavir, 2006) Reyataz (atazanavir, 2003) Viracept (nelfinavir, 1997) INI (integrase inhibitor) elvitegravir (ELV, 2012) Isentress (raltegravir, 2007) HELPFUL RESOURCES AIDSMeds.com www.aidsmeds.com/list.shtml
  • 12. HIV Health & Wellness: Considering treatment and your health care10 The Guidelines list ā€œpreferredā€ and ā€œalternativeā€ HIV regi- mens. Research shows that ā€œpreferredā€ regimens are potent, better tolerated and easier to take. These are listed below. ā€œAlternativeā€ regimens are second choices but may work just as well. These can be found in the Guidelines. PREFERRED REGIMENS NNRTI: Atripla (1x/day), 1 pill Women should get a pregnancy test done before start- ing this pill. One of the drugs in it, Sustiva (efavirenz), can cause birth defects. PI: Prezista/Norvir + Truvada (all 1x/day), 4 pills PI: Reyataz/Norvir + Truvada (all 1x/day), 3 pills People who are taking more than 20mg of omeprazole (an antibiotic) should not start Reyataz. INI: Isentress (2x/day) + Truvada (1x/day), 3 pills This regimen is a little unusual in that one pill is taken once a day while the other is taken twice a day. People should not take both pills of Isentress 1x/day because it does not control HIV as well as taking one pill 2x/day. Pregnancy: Kaletra + Combivir (all 2x/day), 4 pills Ā  more Ā recent Ā updates Ā to Ā the Ā Guidelines Ā for Ā preferred Ā regimens. Recommended regimens for first line treatment (updated March 2012) HELPFUL RESOURCES Guidelines for Treating HIV in Adults www.aidsinfo.nih.gov/guidelines/
  • 13. HIV Health & Wellness: Considering treatment and your health care 11 The most powerful and long- lasting control of HIV comes from a personā€™s first regimen if taken properly. The longer a person can stay on it with- out major side effects or drug resistance, the better. To tell if your regimen is working, you should see a 90% drop in your viral load within a month or two. (See page 5.) Most people can reach an undetectable level within six months, although it may take up to a year if youā€™re over 50 or have another condition like hepatitis C. When a personā€™s viral load remains undetectable for at least one year on treatment, it usually remains that way for at least another two years, assuming they take their meds as prescribed. Some people have been able to stay on their first regimen for up to eight years without having to switch. This is true for almost any regimen. _______ MAIN POINTS TO REMEMBER _______ control of HIV. should drop by at least 90%. months. A few things about your first regimen
  • 14. HIV Health & Wellness: Considering treatment and your health care12 VIRAL LOAD TEST A viral load test is used to check how well treatment is con- trolling HIV. It measures the number of copies of HIV in a small amount of blood. People starting treatment for the first time usually see their viral load fall to an undetectable level within 12ā€“24 weeks. Several things can influence this, including taking the meds as prescribed and the potency of the regimen. Higher viral loads may take longer to respond. CD4 CELL COUNT HIV treatment helps to preserve and increase your CD4 count, which means the immune system is getting better at controlling HIV and other infections. The actual increase will vary from person to person. If you start treatment with a lower CD4 (below 200) it usually takes more time to reach higher counts, or you may not see a large gain. Older people and those with hepatitis C may also have smaller gains. CD4 PERCENTAGE The CD4 percentage shows the proportion of all white blood cells that are CD4s, which in people living with HIV averages about 25% or more. This marker tends to change less often be- tween tests than the CD4 count, and it may be more reliable. A decreasing CD4% over time shows a weakening immune system, and one that falls below 14% is an AIDS diagnosis. Understanding basic test results HELPFUL RESOURCES Blood Work www.projectinform.org/publications/bw/ Understanding Lab Results www.thebody.com/content/art14477.html
  • 15. HIV Health & Wellness: Considering treatment and your health care 13 Resistance testing before starting Drug resistance occurs when HIV mutates, or changes enough so that a drug or regimen doesnā€™t fully control it any- more. Resistance usually occurs when drugs are not taken as prescribed and consistently on schedule. Some people (about 1 out of 9 per year in the US) get a strain of HIV with some level of resis- tance. However, HIV is rarely resistant to all HIV meds, so learning ahead of time which drugs it is resistant to (if any) can help you choose the best regimen. The US Guidelines recommend that people get a geno- typic resistance test before they start or change treatment. People who choose HIV meds guided by resistance test results have better control of HIV over time. To run a resis- tance test, you must have a viral load above 1,000. The test cannot be done accurately if viral load is below 50 copies. _______ MAIN POINTS TO REMEMBER _______ your doctor make better treatment decisions. done when viral load is above 1,000. HELPFUL RESOURCES HIV Drug Resistance Tests www.projectinform.org/publications/resistance/ HIV Drug Resistance Mutations www.iasusa.org/resistance_mutations HIV Drug Resistance Database http://hivdb.stanford.edu
  • 16. 14 HIV Health & Wellness: Considering treatment and your health care HIV meds have not been studied as much in women. Some questions remain about the doses given to women. Female hormones may also affect HIV meds. However, the recommendations for when to start and what to choose are generally the same for both sexes. Women who are not pregnant, planning to become pregnant, breast-feeding or taking hormonal birth control can follow the same guidelines as men. Women sometimes experience both a higher rate and different types of side effects from HIV meds than men, likely due to differences in their weight and body size. In some cases side effects can persist longer for women than for men, but usually decline over time. Oral contraceptives can interact with some HIV meds. Itā€™s not clear whether this actually raises the risk of unintentional pregnancy, but some experts recommend that prescriptions should be changed or other forms of birth control should be used. Women and HIV infection
  • 17. HIV Health & Wellness: Considering treatment and your health care 15 With careful planning and ongoing care, pregnant women can expect to have a safe pregnancy and to give birth to an HIV-negative baby. Although HIV meds have not been well studied in preg- nant women, the US Guidelines rec- ommend that all pregnant women be on treatment to protect themselves and their unborn babies. Some meds appear to be safer, some can be more problematic, and a few others should not be used at all. When making decisions around pregnancy, delivery and nursing, itā€™s wise to consult an HIV-experienced doctor, such as an OB-GYN who has treated HIV- positive women. _______ MAIN POINTS TO REMEMBER _______ for women and men. effects than men. as birth control pills, pregnancy, delivery and nursing.
  • 18. HIV Health & Wellness: Considering treatment and your health care16 Are you ready to start? It can be hard to take medicines and stay on them when youā€™re feeling well. Itā€™s easier to remember and take them when you feel sick because you want to feel better. But HIV meds are taken every day ā€” whether you feel good or feel bad. Itā€™s difficult to fully grasp the meaning of ā€œlifelongā€ treat- ment, but once you start HIV meds you need to stay on them. How do you feel about taking pills every day? Have you taken other medicines or vitamins long-term? How about family or friends? What were their experiences? Adjusting to several changes in your life at once can be hard. You may want to avoid starting meds before disrupt- ing life experiences like going on vacation, moving or start- ing a new job. What flexibility do you have with commit- ments like caring for children or volunteering? How will you carry your meds? Itā€™s generally better to not start until youā€™re ready rather than to start and stop. Youā€™re the expert on when you can start in a way that helps ensure your quality of life. STIGMA For many, privacy is an important consideration when taking HIV medicines. Taking them on time every day or going to regular doctor visits may raise suspicions of some people in your life. Discrimination or disapproval from others can make it challenging to take care of your- self. When possible, discretely telling people who sup- port you may help you stay healthier.
  • 19. Side effects from HIV meds Modern HIV regimens generally have fewer and more manageable side effects, and many people tolerate them quite well. Although most people wonder or worry about side effects, itā€™s impossible to predict who will have them. Some people have few or no side effects, while others have ones that are more troublesome for them. The side effects one person has from a particular medicine does not mean everyone else will have the same ones. Short-term side effects (headache, fever, nausea, etc.) nor- mally appear during the first few weeks of taking a new drug. They often get better or disappear as your body gets used to the meds. They can reappear due to stress or other infections. People with better overall health usually experience fewer short-term side effects. If you start later when youā€™re less healthy, you may experience more side effects. How- ever, if your regimen interrupts your quality of life, you can probably switch to another one that you can tolerate better. You and your doctor will keep track of long-term side effects with routine blood tests. These can include changes in blood fats or in certain blood proteins (such as ALT, AST, amylase and creatinine) that point to possible problems with certain organs, including the liver and kidneys. Over time, these changes can progress to other conditions like more fragile bones or kidney and liver disease. HIV Health & Wellness: Considering treatment and your health care 17 HELPFUL RESOURCES Dealing with Drug Side Effects www.projectinform.org/publications/sideeffects/
  • 20. HIV Health & Wellness: Considering treatment and your health care18 Drug interactions Drug interactions are possible whenever you take two or more drugs together, whether theyā€™re prescriptions, over- the-counter drugs like cold medicine, recreational drugs or even herbal products. Even food can interact with drugs. The more meds you take, such as meds for high blood pres- sure or even erectile dysfunction, the more likely you could experience an interaction. This is also true about taking HIV meds with some herbal products, especially St. Johnā€™s Wort. Not only does each drug or herb have its own possible side effects, they may also increase or decrease the effec- tiveness of other drugs. Drug interactions are not always considered when making treatment decisions, but they can certainly play a major role in its success. Make sure your doctor knows about all the drugs and supplements you take, including over-the-counter products and recreational drugs. Your pharmacist can also be a good resource. Drug interaction tools are also available online. _______ MAIN POINTS TO REMEMBER _______ drugs or herbal products. meds to avoid or correct drug interactions. HELPFUL RESOURCES HIV Drug Interactions www.hiv-druginteractions.org Medwatch www.fda.gov/medwatch
  • 21. HIV Health & Wellness: Considering treatment and your health care 19 Getting your health care covered You may never need to file for disability, but for simplicity we present these options in terms of pre- and post-disability. Disability is a formal claim that must be made with your doctor and approved by Social Security. To find programs you may be eligible for, itā€™s important to consult local resources such as benefits counselors, case managers, social workers or attorneys as programs differ greatly from state to state. IF YOU HAVENā€™T FILED FOR DISABILITY ā€¦ GROUP INSURANCE THROUGH YOUR EMPLOYER If your employer covers health care, the insurance company must cover you even if you have a pre-existing condition like HIV. There are three types of plans: fee-for-service, preferred provider organizations (PPOs), and health maintenance organizations (HMOs). Plans vary in what they offer, their fees and your choice of doctors. Choose a plan that is best for you, and check your plan for HIV-experienced doctors. COBRA If you leave work due to a layoff and had insurance, then you should be offered a continuation policy called COBRA, which is meant to sustain you until you get other insurance. INDIVIDUAL PRIVATE INSURANCE Individual plans are an option, but few people with HIV can purchase them due to high cost and restrictions on pre- existing conditions. If you had coverage before your HIV diagnosis, itā€™s likely most or everything you need will be covered. However, out-of-pocket expenses may be high.
  • 22. HIV Health & Wellness: Considering treatment and your health care20 Getting your health care covered, cont. HIGH RISK INSURANCE POOLS This program covers people who canā€™t get insurance due to pre-existing conditions and operates in 36 states. In addi- tion, under health care reform each state has a Pre-existing Condition Insurance Program (PCIP) in place until 2014 when the large coverage expansions will occur. FEDERAL RYAN WHITE PROGRAM Ryan White funds a broad range of HIV services in states and localities, depending on their unique needs. Itā€™s intended to help under- or uninsured people. If you have insurance, you may get help with premiums or other out-of-pocket costs. If you donā€™t have insurance, your state program may help you purchase it. You may also get free or very low cost care through HIV clinics and the AIDS Drug Assistance Program (ADAP). Ryan White may also fund dental and vision care. Check with your state AIDS program or ASO to see if a Ryan White program can help you. IF YOU HAVE AN APPROVED DISABILITY CLAIM ā€¦ COBRA If you leave work due to disability and had insurance, youā€™ll be offered COBRA until you can get other insurance like Medicare. Coverage is often expensive. Check with a local ASO or state AIDS office for programs to help with out-of- pocket costs. MEDICAID Most people with HIV qualify for Medicaid through its disability category, although some women with children can qualify through a different program. Nearly all states
  • 23. HIV Health & Wellness: Considering treatment and your health care 21 Getting your health care covered, cont. require a disability claim, income and assets below a certain level to qualify. Several states offer Medicaid to all childless adults (AZ, DE, HI, MA, NY and VT), while several others offer some benefits. States vary greatly in what they cover and who qualifies. MEDICARE (www.medicare.gov) If you have held a job, youā€™ll likely qualify for Medicare. However, you must wait 29 months after your disability claim, during which you may be able to get your health care through COBRA, Ryan White or Medicaid. OTHER POSSIBLE SOURCES OF HELP PATIENT ASSISTANCE PROGRAMS (PAPs) PAPs are run by HIV drug makers to supply meds to people who are under- or uninsured. They differ widely in eligibility. These are not ideal for the long-term but can help in the short-term or in an emergency. VETERANS ADMINISTRATION (www.hiv.va.gov) If youā€™re a veteran or family member, youā€™re eligible for care through the VA. VA sites are only found in some areas and vary in their ability to provide HIV care. As a veteran, you can access Ryan White programs, but if your VA facility is acces- sible and offers quality HIV care, it may be a good option. HELPFUL RESOURCES Welvista (access HIV meds for those on ADAP wait lists) www.welvista.org Federal resource on health care www.healthcare.gov Pre-existing Conditions Insurance Plans www.pcip.gov, www.pciplan.com List of PAPs for HIV meds www.fairpricingcoalition.org Social Security Administration www.socialsecurity.gov
  • 24. HIV Health & Wellness: Considering treatment and your health care22 You will need to find a doctor whoā€™s able and willing to treat HIV, ideally one who already has experience with HIV. Depending on how and where you get health care, you may not have many choices. Experienced doctors usually keep up with recent develop- ments in treating HIV. They also have a better sense of preventive health care. If you can, itā€™s also important to find other doctors like gynecologists, eye doctors and dentists who have HIV experience. Doctors with less or no HIV experience may need to consult resources that can help them provide the best medical care for you. Resources are available that can help you and your doctor make informed decisions. The WarmLine (National HIV/AIDS Cliniciansā€™ Consul- tation Center) provides expert clinical advice to medical professionals. Itā€™s available Mondayā€“Friday, 8amā€“8pm, Eastern Time. (See below.) Is your doctor experienced in treating HIV? HELPFUL RESOURCES WarmLine 800-933-3413 (for doctors only), www.nccc.ucsf.edu/about_nccc/warmline/ AIDS Education Training Centers www.aids-ed.org Clinical Care Options www.clinicaloptions.com GLMAā€™s Find a Provider www.glma.org, click FIND A PROVIDER HIVMAā€™s Find a Provider www.hivma.org, click FIND AN HIV PROVIDER AAHIVMā€™s Find a Provider www.aahivm.org, use REFERRALLINK at right
  • 25. HIV Health & Wellness: Considering treatment and your health care 23 Important questionsImportant questions FOR YOUR DOCTOR: Do you start every patient on treatment at the same time, or on the same regimen? Why or why not? Should I be concerned about HIV meds inter- acting with other drugs or herbs that Iā€™m taking? Should I be concerned about drug resistance, and how do I keep ahead of it? What tests or prescrip- tions are covered by my insurance (public or private)? How do blood tests inform my decision to start treatment? What vaccines do you recommend I get? Why? What if Iā€™m not ready to start treatment? Are there are any other tests that I should take before starting an HIV regimen? FOR OTHERS: Have you started on HIV meds? Why or why not? What was important for you to understand to help you make a decision about starting meds? When did you know it was the right time to start? What other ways do you keep yourself healthy? Do you know of support groups or agencies that help people talk about these decisions? How do you make sure you take every dose of your meds every day? How did your blood work inform your deci- sion to start? Did other things affect your treatment decision? What HIV treatment information do you rely on? Why?
  • 26. HIV Health & Wellness: Considering treatment and your health care24 Checklist for getting started I am (am not) ready to start taking HIV meds, and under- stand the reasons why I want (donā€™t want) to start. My CD4 count is _______. The trend is stable, increasing, decreasing. My viral load is _______. The trend is stable; increasing; decreasing. I have a good understanding of the risks and benefits of starting treatment according to my individual needs. I have thought about how HIV treatment may impact my life. Iā€™ve considered the issues around taking HIV meds and oral birth control, or HIV meds and pregnancy. I have private or public insurance or another way to cover the cost of my doctor visits, medicines and blood work. I know where to go to get other types of support, like mental health or housing services, that will help me stay healthy. I will ask how to properly take my medicines. I understand how my doctor and I will check to see if my regimen is working. I know what side effects may give me the most problems, like nausea or diarrhea, and which likely get better over time. Iā€™m aware of what I can do to help avoid or lessen side effects. If I want privacy when taking my meds, Iā€™ve thought about how to ensure that. If I have questions and my doctor is not available, I can call _________________ or __________________.
  • 27.
  • 28. 273 Ninth Street San Francisco, CA 94103 www.projectinform.org/HIVhealth/ To order copies: booklets@projectinform.org. To give feedback: www.projectinform.org/HIVhealth/. To get e-newsletter: www.projectinform.org/signup/.