Options

Your treatment options should be explored on the basis of all the information, scientific and anecdotal, that you can get. Remember that your doctor is not the only source of information on treatments.  Also bear in mind that this website only offers a brief introduction to the issues, you might want to research them further before taking any treatment decisions.

When to start treatment

Research has still not identified the best time to begin treatment with anti-viral drugs. Many people infected with HIV are living 10, 15 years or more without taking any anti-HIV treatment.  On the other hand, there are many people living equally well on anti-HIV drugs. One thing is for sure, the death rate from AIDS has been slashed since the introduction of combination therapy (taking different types of HIV drugs to suppress the virus).

Doctors in the UK have predominantly not subscribed to the American idea of "hit hard, hit early" when treating HIV.  The UK's more measured approach seems to have been the right one because, while ant-HIV medications are effective, they can also be difficult to take and bring with them side effects that impact on your quality of life.guidelines stress that treatment should begin before irreversible damage to the immune system occurs.

UK doctors' guidelines

In summary, if your CD4 count falls below 350, you should consider starting anti-HIV therapy. The decision may be affected by other issues like whether you also have Hepatitis C as the treatment for this can complicate HIV therapy.

The British HIV Association (BHIVA) guidelines published in 2001 recommend  not starting treatment for the patients who have:

• CD4 count over 350 at any viral  load;
• CD4 count between 200 and  350 cells/mm 3 with a viral load below 100,000.
• Close monitoring (every two or three months) of individuals with rapidly declining CD4 counts  (> 80 cells per year), rapidly rising viral loads or a high viral load (over  100,000 copies) is recommended.

The guidelines also stress the importance of making an individualised decision about the risks and benefits of starting treatment, based on:

• risk of disease progression judged by  viral load and CD4 count;
• knowledge about long-term side effects such as lipodystrophy,  diabetes;
• psychological burden of  lifelong therapy;
• difficulties of  adherence in symptom-free disease and likelihood that adherence will deteriorate over time.

Research is also being undertaken into the value of treatment within six months of HIV infection. This is to see whether the body's immune system can be helped to deal with HIV soon after infection by taking a course of anti-HIV drugs.  The results will take years to be known.

Side effects

All anti-HIV therapy has potential for side effects. Each person is different and some people cannot tolerate drugs that others cope with quite well. Some people find side effects to intolerable that they have to change drugs or stop treatment altogether.

Your doctor should discuss any treatment and side effects with you fully.  Side effects can be easier to cope with if you know what to expect and what to do if they happen to you. You should know what is likely to happen before you decide to start any particular treatment. Unfortunately, doctors don't always explain things fully (and patients don't always listen), omitting to mention or playing down any negative possibilities. For this reason, you might be better off doing your own research as well as listening to your doctor.

Prophylaxis

We know certain opportunistic infections are more likely when your CD4 count falls below a certain level.  Your doctor should then propose prophylaxis (taking maintenance doses of certain drugs to try to control or prevent other infections).

Prophylaxis is available for many illnesses that could make your life very difficult or painful. People living with HIV are now much less likely to develop PCP (a form of pneumonia) due to widespread use of prophylaxis.  Some prophylactic drugs also come with side effects.

Clinical Trials

One way to access promising new therapies before they become widely available is through taking part in a clinical trial that scientifically assesses their value.

Clinical trials should not be treated lightly as they also study the side effects or other damage that a new drug might cause. Again, finiding out everything that the trial entails before deciding to go ahead is advisable.

Complementary therapies

Conventional medicine has tended to ignore the benefits of complementary therapy which takes a more "holistic" approach, dealing with the whole body, the mind and the "spirit", rather than focusing solely on one symptom or area.

Many people find major benefit in complementary therapies such as massage, aromatherapy, acupuncture, shiatsu, reflexology, meditation, etc. Apart fromtreating physical symptoms, most of these therapies help you deal with stress, relaxing and refreshing you in the process.

While some complementary therapies can cause side effects or interfere with conventional medicine (be very careful with St John's Wort for example - discuss taking it with your HIV doctor before taking any if you are on HIV drugs as well), don't dismiss the contribution that complementary therapies may be able to make to your life without trying them first. Many AIDS organisations and some clinics offer a range of therapies at little or no cost to patients with HIV.