April 14, 2010

April 14, 2010
Adherence and Resistance

Welcome to another day in my life. Today is Wednesday and we have made it to the middle of another week. While it rained last night, most of today was party cloudy with the occasional bursts of sunlight here in south Florida.

I had an early afternoon conference call which was hosted by Randy Allagier from San Francisco. We discussed the upcoming AIDS Watch 2010 event in Washington, DC; the problem with PLWHA involvement on planning councils and other issues. Unfortunately, there were mainly people from California and Florida on the call so I hope we are able to recruit more PLWHAs for the calls.

One item of interests to all people living with HIV and AIDS is adherence and resistance to life saving HIV medications. Adherence deals with how often a person follows their HIV medication regimen. Resistance is when the life saving HIV medications you are taking no longer suppress the virus and your viral load starts increasing.

HIV treatment can mean a longer and healthier life. You will get the most benefit from your treatment if you take it properly. If you do not take HIV treatment properly, then your HIV may become resistant to the drugs you are taking and possibly other, similar drugs.

So for today, let us discuss why taking your medications properly is so important.

The outlook for people with HIV in the US has never been better. The right treatment and care can mean that you have a good chance of living a long and healthy life, with a near normal lifespan.

The currently available anti-HIV drugs (‘antiretrovirals’) cannot cure HIV. However, treatment with a combination of these drugs (usually three) can reduce the amount of HIV in your blood (your viral load) to such a low level that it cannot be detected using laboratory tests. This is called an ‘undetectable’ level. An undetectable viral load is the aim of HIV treatment. Having an undetectable viral load means that your immune system can stay strong and fight off infections.

There is very good evidence that the HIV treatment available today will work against the virus in the long term and keep your viral load undetectable indefinitely.

However, for this to be the case, it is very important to take your HIV treatment properly. This is often called adherence and it is the most important factor under your control in the success of your HIV treatment.

Not taking your HIV treatment properly can mean that the levels of the drugs in your blood are not high enough to properly fight HIV. If this happens, your HIV will be able to reproduce. The strains of HIV that reproduce when you’re taking HIV treatment can develop resistance to the drugs you are taking. Resistance can mean that your HIV treatment will not work properly.

Your treatment not working is likely to mean that your viral load will increase and your CD4 cell count, an important indicator of the health of your immune system, will fall. This situation increases your chances of becoming ill because of HIV.

If your viral load increases to detectable levels, then you will need to change your HIV treatment. While there is more choice available now, this new treatment might be more difficult to take than the combination you were taking before and could involve a risk of more or new side effects.

You may also become resistant to drugs similar to those you are currently taking. This is called cross resistance and the risk varies between different classes of HIV drugs. You can find out more about the different drug classes in the NAM booklet Anti-HIV Drugs.

When taken properly, HIV treatment can also lower viral load in genital fluids to undetectable levels. This can reduce the risk of HIV transmission during sex. A consequence of not taking your HIV treatment properly can be that the amount of virus in your genital fluids increases, therefore increasing the risk of passing on HIV to your sexual partners and the type of HIV which you pass on may be resistant to one or more of the drugs.

Taking your drugs properly is often called adherence. Adherence to your HIV treatment means:

* Taking all the medicines that make up your HIV treatment combination in the right quantities.
* Taking your medicines at the right time. Taking your medicine too late can be as bad as not taking it at all.
* Following any instructions about food. Some medicines need to be taken with food so they are absorbed properly, but others need to be taken on an empty stomach.

Checking for interactions with other medicines or drugs. This includes medicines that a doctor prescribes to you, as well as those bought over the counter. It’s also important to know that some herbal and alternative medicines can interact with some anti-HIV drugs, as can some recreational and illegal drugs.

Tomorrow, I will discuss more about adherence in our fight to keep the virus from increasing in viral load and maintaining our health.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab