CD4 counts also indicate how well your treatment regimen is working. Your CD4 count should be tested every 3 to 6 months
throughout your treatment. HIV treatment should increase your CD4 count or at least keep it from going down. Talk to your doctor if you are concerned about your
CD4 counts.
My doctor wants to change my treatment regimen. Why?
There are several reasons why you may need to change your treatment regimen. Two of the most important
reasons are drug toxicity and regimen failure.
Drug toxicity means that your treatment regimen creates side effects that make it difficult for you to take the drugs.
Regimen failure means that the drugs are not working well enough. See HIV Regimen Failure for more information about regimen failure.
Ask your doctor to explain why you need to change your treatment. If the reason is drug toxicity, your doctor may change one or more of the drugs in your
regimen. If the reason is regimen failure, your doctor should change all of your drugs to medications that you have never taken before. If you have been taking
three drugs and all three drugs cannot be changed, at least two drugs should be changed. Using new drugs will reduce the risk of drug resistance. See
Changing Regimens Fact Sheet for more information about changing treatment regimens.
Terms Used in This Fact Sheet |
Adherence: how closely you follow, or adhere to, your treatment regimen. This includes taking the correct
dose at the correct time as prescribed by your doctor. |
Baseline: an initial measurement (such as CD4 count or viral load) made before starting therapy and used
as a reference point to monitor your HIV infection. |
CD4 count: CD4 cells, also called T cells or CD4+ T cells, are white blood cells that fight infection.
HIV destroys CD4 cells, making it harder for your body to fight infections. A CD4 count is the number of CD4 cells in a sample of blood. |
Drug Resistance: HIV can mutate (change form) while a person is taking anti-HIV medication. This may result in
HIV that cannot be controlled with certain medications. |
Viral Load: the amount of HIV in a sample of blood. |
Health Information for Patients
Fact Sheet #7
HIV Treatment Regimen Failure
What is regimen failure?
Regimen failure occurs when the anti-HIV medications you are taking do not adequately control the infection.
Factors that may cause regimen failure include:
- Poor health before starting the treatment regimen
- Poor adherence to the regimen (not taking medications exactly as instructed by your doctor, including missed doses)
- Previous anti-HIV treatment and/or drug resistance
- Alcohol or drug abuse
- Medication side effects, medication toxicity, or interactions with other medications
- Medication poorly absorbed by the body
- Medical conditions or illnesses other than HIV infection
What are the three types of regimen failure?
- Virologic failure: Regimens should lower the amount of HIV in your blood to undetectable levels. Virologic failure has occurred if HIV can still be detected
in the blood 48 weeks after starting treatment, or if it is detected again after treatment had previously lowered your viral load
to undetectable.
- Immunologic failure:An effective regimen should increase the number of CD4 cells in your blood or at least prevent the number from going
down. Immunologic failure has occurred if your CD4 count decreases below a baseline
count or does not increase above the baseline count within your first year of therapy.
- Clinical failure: Clinical failure has occurred if you experience an HIV-related infection or a decline in physical health despite at least 3
months of anti-HIV treatment.
Virologic failure is the most common kind of regimen failure. People with virologic failure who do not change to an effective drug regimen usually progress to
immunologic failure within about 3 years. Immunologic failure may be followed by clinical failure.
What happens if my regimen fails?
If your treatment regimen fails, your doctor will evaluate your treatment history, medication side effects, problems
you may have had with taking the medications as directed, your physical condition, and results of drug resistance testing to determine why your regimen is failing.
You and your doctor may then select a new drug regimen to better control your infection. See Changing Regimens Fact Sheet for more
information about changing treatment regimens.
Terms Used in This Fact Sheet |
Baseline measurement: aan initial measurement (such as CD4 count or viral load) made before starting therapy
and used as a reference point to monitor your HIV infection. |
CD4 count: CD4 cells, also called T cells or CD4+ T cells, are white blood cells that fight infection.
HIV destroys CD4 cells, making it harder for your body to fight infections. A CD4 count is the number of CD4 cells in a sample of blood. |
Drug Resistance: HIV can mutate (change form) while a person is taking anti-HIV medication. This may result in HIV
that cannot be controlled with certain medications. |
Toxicity: the harm a medication can do to your body. |
Viral load: the amount of HIV in a sample blood. |
Health Information for Patients
Fact Sheet #8
Changing My HIV Treatment Regimen
How will my doctor and I know what medications to use next?
Before changing your treatment regimen, your doctor will try to find out why your current regimen is not working (see
HIV Regimen Failure Fact Sheet for causes of regimen failure). Your doctor will evaluate your
adherence to the regimen, the regimen's tolerability, and medication interactions. Whether you and your doctor decide to change your
regimen and what new medications you will take will depend on why your current regimen is failing.
What is adherence?
Adherence refers to how closely you follow (adhere to) your treatment regimen. If your regimen is failing because you cannot
adhere to it, you and your doctor should discuss why you are having difficulty taking your medication and what you can do to improve your adherence. Your doctor
may change your regimen to reduce the number of pills you take or how often you take them. For more information about adherence, see
Adherence and Adhering to a Regimen Fact Sheets.
What is tolerability?
Tolerability refers to how many and what types of negative medication side effects you experience. If the side effects are
severe, you may need to change your regimen. Your doctor will ask you what side effects you have and how long you have had them. You and your doctor will
decide whether to treat the side effects or to change your anti-HIV medications.
What are medication interactions?
Anti-HIV medications may interact with other medications you are taking. This may reduce the effectiveness of the
medications or increase the risk of negative side effects. You and your doctor should review all of your medications, including over-the-counter medications and
herbal remedies. You should also review whether your medications should be taken with food or on an empty stomach.
Changing Regimens
If your regimen is failing and you and your doctor have ruled out adherence, tolerability, and medication interactions,
you should consider changing your regimen. Before changing anti-HIV medications, talk with your doctor about:
- anti-HIV medications you have taken before
- the strength of the new medications your doctor recommends
- possible side effects of the new medications
- how well you will be able to adhere to the new regimen
- the number of anti-HIV medications that you have not yet used
Your doctor will confirm that your regimen is failing with at least two viral load tests and three
CD4 count counts. You should also be tested for drug resistance
while you are taking the failing regimen.
In general, your new treatment regimen should include three or more medications. You and your doctor will choose the medications based on your medication
history, results of resistance testing, and medication side effects. If you have already taken many of the FDA-approved anti-HIV medications, your doctor may
recommend a new medication under investigation. You may be eligible to participate in a clinical trial using new drugs or treatment strategies. For more
information about participating in a clinical trial, ask your doctor, or visit the "Clinical Trials" section of the AIDSinfo Web site at:
http://aidsinfo.nih.gov/clinical_trials/.
Terms Used in This Fact Sheet |
CD4 count: CD4 cells, also called T cells or CD4+ T cells, are white blood cells that fight infection.
HIV destroys CD4 cells, making it harder for your body to fight infections. A CD4 count is the number of CD4 cells in a sample of blood. |
Drug Resistance: HIV can mutate (change form) while a person is taking anti-HIV medication. This may result in HIV
that cannot be controlled with certain medications. |
Viral load: the amount of HIV in a sample blood. |
Health Information for Patients
Fact Sheet #9
What is Treatment Adherence?
What is adherence?
Adherence refers to how closely you follow a prescribed treatment regimen. It includes your willingness to start treatment and
your ability to take medications exactly as directed.
Is adherence important for HIV treatment?
Yes! Adherence is a major issue in HIV treatment for two reasons:
- Adherence affects how well anti-HIV medications decrease your viral load. When you skip a medication dose, even
just once, the virus has the opportunity to reproduce more rapidly. Keeping HIV replication at a minimum is essential for preventing AIDS-related conditions and
death.
- Adherence to HIV treatment helps prevent drug resistance. When you skip doses, you may develop strains of HIV that
are resistant to the drugs you are taking and even to drugs you have not yet taken. This may leave you with fewer treatment options should you need to change
treatment regimens in the future. Because drug-resistant strains can be transmitted to others, engaging in risky behavior can have especially serious consequences.
Although there are many different anti-HIV medications and treatment regimens, studies show that your first regimen has the best chance for long-term
success. Taking your drugs correctly (adherence) increases your odds of success.
Why is adherence difficult for many people with HIV?
HIV treatment regimens can be complicated; most regimens involve taking multiple pills each day. Some anti-HIV medications
must be taken on an empty stomach, while others must be taken with meals. This can be difficult for many people, especially for those who are sick or are
experiencing HIV symptoms or negative drug side effects.
Other factors that can make it difficult to adhere to an HIV treatment regimen include:
- Experiencing unpleasant medication side effects (such as nausea)
- Sleeping through doses
- Traveling away from home
- Being too busy
- Feeling sick or depressed
- Forgetting to take medications
What can I do to adhere to my treatment regimen?
There are many things you can do to better adhere to your treatment regimen.
Adhering to a Regimen Fact Sheet discusses what you can do to improve your adherence both before and after you start taking anti-HIV
medications.
One of the most important things you can do when starting a treatment regimen is to talk with your doctor about your lifestyle. He or she will then be able to
prescribe a regimen that works best for you. Topics you should address with your doctor include:
- Your travel, sleep, and eating schedule
- Possible side effects of medication
- Other medications you are taking and their possible interaction with anti-HIV medications
- Your level of commitment to following an HIV treatment regimen
Many people adhere well to their treatment early on, but find adherence becomes more difficult over time. Talk with your doctor about adherence during every
visit. Your commitment to a treatment plan is critical; studies show that patients who take their medications correctly achieve the best results.
Terms Used in This Fact Sheet |
Drug Resistance: HIV can mutate (change form) while a person is taking anti-HIV medication. This may result in HIV
that cannot be controlled with certain medications. |
Viral load: the amount of HIV in a sample blood. |
Health Information for Patients
Fact Sheet #10
Adhering To My HIV Treatment Regimen
What should I do before I begin treatment?
Before you begin an HIV treatment regimen, there are several steps you can take to help you with
adherence:
- Talk with your doctor about your treatment regimen.
- Get a written copy of your treatment plan that lists each medication, when and how much to take, and if it must be taken with food or on an empty stomach.
- Understand how important adherence is (see Adherence Fact Sheet).
- Be honest about personal issues that may affect your adherence. Adherence may be harder for people dealing with substance abuse or alcoholism, unstable
housing, mental illness, or other life challenges.
- Consider a "dry run." Practice your treatment regimen using vitamins, jelly beans, or mints. This will help you determine ahead of time which doses might be
difficult to take correctly.
- Develop a plan that works for you.
Many people find it helpful to identify the activities they normally do at the times they will be taking their medication. People who arrange their medication
schedule around their daily routines adhere to their treatment plans better than those who do not.
How can I maintain adherence after I start treatment?
- Take your medication at the same time each day.
- Put a week's worth of medication in a pill box at the beginning of each week.
- Use timers, alarm clocks, or pagers to remind you when to take your medication.
- Keep your medication in the place where you will take it. You may want to keep backup supplies of your medication at your workplace or in your briefcase or
purse.
- Keep a medication diary. Write the names of your drugs in your daily planner, then check off each dose as you take it.
- Plan ahead for weekends, holidays, and changes in routine.
- Develop a support network of family members, friends, or coworkers who can remind you to take your medication. Some people also find it helpful to join a
support group for people living with HIV infection.
- Monitor your medication supply. Contact your doctor or clinic if your supply will not last until your next visit.
What should I do if I have problems adhering to my treatment regimen?
It is important that you tell your doctor right away about any problems you are having with your treatment plan. If you are
experiencing unpleasant side effects, your dose may need to be adjusted or you may need a change in your regimen (see
Changing Regimen Fact Sheet for more information about changing your treatment regimen). Missed doses may be a sign that your treatment plan is too
complicated or unrealistic for you to follow. Talk with your doctor about other treatment options. Your doctor needs to stay informed to help you get the most
out of your treatment regimen and to provide workable treatment options.
Term Used in This Fact Sheet |
Adherence: how closely you follow, or adhere to, your treatment regimen. This includes taking the correct
dose at the correct time as prescribed by your doctor. |
Health Information for Patients
Fact Sheet #11
HIV and Pregnancy
I am HIV positive and pregnant. Should I take anti-HIV medications?
You should take anti-HIV medications if:
- you are experiencing severe symptoms of HIV or have been diagnosed with AIDS
- your CD4 count is 200 cells/mm3 or less
- your viral load is greater than 1,000 copies/mL
You should also take anti-HIV medications to prevent your baby from becoming infected with HIV. Specific treatment to prevent
mother-to-child transmission of HIV is discussed below.
What medications should I take if I am pregnant or think I might become pregnant?
If you are pregnant or may become pregnant, you should consider the risks and benefits of HIV treatment to both you and your
child. Some medications (such as Sustiva) should be avoided because they may cause birth defects if taken early in pregnancy. The effects of
other anti-HIV medications are not yet known. It is important for you to talk with your doctor before and during your pregnancy so that together you can decide on
the best treatment for you and your baby.
To reduce the risk of passing HIV to your baby, your treatment regimen should include a three-part ZDV (also known as zidovudine, AZT, or
Retrovir) regimen.
What is the three-part ZDV regimen?
- HIV infected pregnant women should take ZDV starting at 14 to 34 weeks of pregnancy. You can take either 100 mg five times a day, 200 mg three times a
day, or 300 mg twice a day.
- During labor and delivery, you should receive ZDV intravenously (through an IV in the vein).
- Your baby should take ZDV (in liquid form) every 6 hours for 6 weeks after he or she is born.
I am already on an HIV treatment regimen. Do I need to change my medications?
If you are already taking anti-HIV medications, talk with your doctor about the potential risks and benefits to your baby if you
decide to continue your treatment regimen during your pregnancy. You and your doctor may decide to change your medications or change your medication
dose. Make sure that your regimen includes the appropriate dose of ZDV.
In general, efavirenz (Sustiva), stavudine (Zerit), hydroxyurea, and the oral liquid form of amprenavir (Agenerase) should not be used during pregnancy.
Will my baby be born HIV infected?
No one can tell you for sure if your baby will be born HIV infected. The three-part ZDV regimen has been shown to reduce the
risk of passing HIV to your baby by almost 70%.
Additional anti-HIV medications can treat your infection and may provide extra protection for your baby. However, the possible problems with using multiple
medications during pregnancy are not well understood.
Other actions to help you protect your baby include getting regular prenatal care and adhering to your HIV drug treatment plan (see Adherence
and Adhering to a Regimen Fact Sheet).
Terms Used in This Fact Sheet |
CD4 count: CD4 cells, also called T cells or CD4+ T cells, are white blood cells that fight infection.
HIV destroys CD4 cells, making it harder for your body to fight infections. A CD4 count is the number of CD4 cells in a sample of blood. |
Mother-to-child transmission: also called perinatal transmission. HIV may be passed from an HIV infected
mother to her baby during pregnancy or delivery. HIV may also be passed from mother to child through breast milk. |
Viral Load: the amount of HIV in a sample blood. |
This information is based on the U.S. Public Health Service's Recommendations for Use of Antiretroviral
Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States
(available at http://aidsinfo.nih.gov).
Health Information for Patients
Fact Sheet #12
Understanding HIV Prevention
I am HIV positive and don't want to infect others. What should I do?
Understanding how HIV is transmitted is an important step in prevention. Talk with your doctor about how HIV is transmitted
and what you can do to prevent infecting others. Each time you visit your doctor, discuss your high-risk behaviors, such as unprotected sex and needle
sharing.
You may feel reluctant to talk with your doctor about your high-risk behaviors. It can be difficult to change behaviors, even when you want to. However, it is
important to be honest with your doctor about risky activities. You and your doctor can then discuss ways to minimize the risk of infecting others.
If you are a woman, you and your doctor should discuss ways to prevent pregnancy. If you want to become pregnant, you and your doctor can talk about what you
should do to prevent transmitting HIV to your baby (see HIV and Pregnancy Fact Sheet).
How can I prevent infecting someone else?
Successful HIV treatment can lower your viral load, which may reduce the risk of HIV transmission. But there are other factors
that influence sexual transmission of HIV, such as:
- presence of other sexually transmitted diseases (STDs)
- genital irritation
- menstruation
- lack of circumcision in men
- taking birth control pills
- hormone imbalances
- vitamin and mineral deficiencies
Always use prevention strategies, such as condoms and safer sex practices. If you inject drugs, don't share your works with anyone else. Talk with your doctor if
you have trouble sticking to these prevention strategies. You and your doctor can then find ways to make your high-risk behaviors safer.
Should I tell my partners that I am HIV infected?
Yes. It is very important that you tell your sexual partners and people with whom you have shared injected drugs that they may
have been exposed to HIV and should be tested. You and your doctor can discuss the best way to notify your partners. Some health departments and HIV clinics
have anonymous partner notification systems–your partners are told that they have been exposed, but are not told who reported their names or when the reported
exposures occurred.
I am taking anti-HIV medications and my viral load is undetectable. Am I cured? Can I infect others?
An undetectable viral load does not mean that you are cured. It means that the amount of HIV virus in your blood is so low that
the viral load tests cannot detect it. You are still infected with HIV and can infect others. You should continue to use prevention strategies and should see your
doctor regularly.
It is important to use HIV prevention strategies even if your partner is also HIV infected. Your partner may have a different strain of the virus that could act
differently in your body or be resistant to different anti-HIV medications.
For more information:
The Centers for Disease Control and Prevention (CDC) National Prevention Information Network (NPIN) provides information
about prevention of HIV infections, other sexually transmitted diseases, and tuberculosis.
If you have questions about ways to prevent transmitting HIV, contact your doctor or a CDC NPIN Information Specialist at 1-800-458-5231 or
http://cdcnpin.org.
This information is based on the U.S. Department of Health and Human Services'
Incorporating HIVPrevention into the Medical Care of Persons Living with HIV
(available at http://aidsinfo.nih.gov).
Reviewed: September 2004