Combination therapy:

Combination therapy is the term for using three or more drugs to treat HIV. Treatment works for women, men and children. It works no matter how you were infected with HIV. At some point, most HIV-positive people will need treatment. It is recommended to start treatment before your CD4 count falls below 200.

What is combination therapy?

Combination therapy is the term for using three or more drugs to treat HIV. It is also called triple or quadruple therapy or HAART (Highly Active Anti-Retroviral Therapy).HIV drugs are also called ARVs. These drugs work in different ways and at different stages of the HIV life cycle.

Do the drugs really work?

In every country that uses HAART, AIDS-related deaths and illnesses have dropped dramatically.Treatment works for women, men and children. It works no matter how you were infected with HIV. Whether this was sexually, through IV drug use, or by blood transfusion. Taking HIV drugs, exactly as prescribed, will reduce the virus in your body to tiny amounts. This then lets your immune system recover and get stronger by itself. Regular monitoring, using blood tests, will check that the drugs continue to work Viral load tests measure the amount of HIV in your blood. Results are given as copies/mL. CD4 tests measure how strong your immune system is. Results are given as cells/mL. mL is an abbreviation for millilitre or cubic millimetre, a standard measurement for volumes of liquid – another abbreviation for this is mm3 Even if you start with a very low CD4 count, you could regain enough of your own immune system for your body to recover from many HIV-related illnesses.If you use HIV treatment at the right time, and in the right way, you should stay well much longer.

How long will the drugs work?

Combination therapy using at least three drugs has now been used for over ten years. Many of the individual drugs have been studied for even longer.The length of time that any combination will work depends mainly on you not developing resistance. This depends on getting, and keeping, your viral load to undetectable levels, below 50 copies/mL.If your viral load stays undetectable, you can use the same combination for many years.UK guidelines state that getting your viral load below 50 is a main goal when starting treatment.

Does everyone need treatment?

At some point, most HIV-positive people will need treatment. When people will need it though, can vary a lot. HIV infection progresses in different people at very different rates. About one third of HIV-positive people will stay well for up to 10 years after infection, even without treatment. About 60% will start treatment after 4-5 years. 2-3% of people can become ill more quickly and need treatment much earlier. 2-3% can go for 15-20 years without treatment. Whether you need treatment is something you have to discuss with your doctor. This will usually take place over several visits.

When discussing treatment:

• Ask as many questions as possible until you are happy with the answers.
• Get useful information from other sources. This includes the internet, friends, newsletters and phonelines.
• Even if you are well, it is a good idea to get to know something about treatment now, before you need it. This is particularly important if your CD4 count is falling, or if you have a high viral load.

When should I start treatment?

When to start treatment is something you and your doctor must discuss together. You are the person who has to take the pills. So you have the choice over whether you start, as well as which drugs you use.It is recommended to start treatment before your CD4 count falls below 200. Even at this level, there is unlikely to be an urgent need for you to start treatment straight away, if you are not ready.Ask your doctor to tell you about the different drugs that you can use. You need to know the good and bad things about each of them. Take time to think about what you want to do. Do not feel rushed or pressurised into doing something you don’t understand. If you have only recently been diagnosed HIV-positive, you will need to deal with that first. Although you may be worried about using treatments, HIV and AIDS is still a very real and life-threatening illness. It is possible to delay treatment until it is too late. Illnesses that can occur at any time when your CD4 count is below 200 can be fatal. While your CD4 count is above 300 you still have a good immune system. Below 300 you are at a higher risk of infections that cause diarrhoea and weight loss.If your CD4 count falls below 200, your risk of developing a pneumonia called PCP increases. If it falls below 100, then your risk of serious illnesses increases even further.A low CD4 count does not mean that you will definitely become ill. It is, however, much more likely. Most of the drugs used to treat these HIV-related illnesses can be more toxic and difficult to take than regular anti-HIV drugs.

Don’t look at the drugs you start with now as a treatment that you will be taking forever. Look at them as something you have to be really committed to for the next couple of years. Take this new aspect of your life more seriously than anything else until you get it right.

Different drugs work at different stages of the HIV life cycle

HIV uses CD4 cells as factories to make hundreds of copies of itself - entry inhibitors work by stopping HIV getting into the CD4 cell, nukes & non-nukes (NNRTIs) work by stopping one of the main ways HIV reproduces inside the CD4 cell, protease inhibitors work by stopping any new HIV virus from leaving the CD4 cell.

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