| Choosing the Right Combination
Therapy
Deciding whether to treat
or not to treat HIV is one tough choice, but carefully considering
what combination of drugs you take is also important. All drugs
are not created equal in their side effects or dosing requirements,
and the more you learn before you start, the more likely it is that
you'll be able to continue treatment without the risks involved
in stopping or switching. Remember, HIV treatment is forever: a
lifetime commitment. Like any "marriage," this is one you probably
don't want to rush into.
The three different classes of FDA-approved anti-HIV medications
are:
- protease inhibitors
- non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- nucleoside/nucleotide analogue reverse transcriptase inhibitors
These drugs get their names from where/when in the HIV virus's
reproductive cycle they take effect. Current thinking is to use
a combination of two nucleosides and one protease or NNRTI, which
interferes with two different points of the virus's reproductive
cycle. Some practitioners will also prescribe a triple nucleoside
regime. These guidelines — and the list of available drugs
— change fairly often, so visit www.aidsinfo.nih.gov
for the government's latest list.
Why is it important to think it through before you start?
Compared to drugs for many other chronic illnesses, the typical
antiretroviral regimen (technically known as highly active antiretroviral
therapy or HAART) is no picnic. If you're prescribed a drug for,
say, high blood pressure, chances are the dose will be one pill
a day, and if you lose weight and stick to a diet, you may eventually
need less or no medication. But for people with HIV, starting medication
may be a life-long commitment. Taking medication may mean feeling
sick for this first time, not as a result of HIV, but as a result
of the side effects of the medication. It may mean having to confront
many new realities, foremost among them, perhaps, the constant reminder
of having HIV. It will mean learning to take lots of pills, scheduling
meals, putting up with side effects and scrutinizing the results
of blood tests more closely than ever before.
So, which drug to take?
Which drug you take depends on which side effects and meal requirements
you feel most able to master. Some people try the Tic-Tac test,
following the dietary and time requirements of a given combination
for a weekend, but taking a mint instead of a medicine at the appropriate
time. Others look at combinations in terms of convenience: if you
travel regularly for business through three time zones, you're probably
better off taking as few daily doses as possible. If you work somewhere
with no convenient bathroom, you may not want to take a drug that
requires you to drink a quart or more of water daily, or those that
cause diarrhea. In addition to finding out about nutritional requirements,
make sure you also find out about drug interactions, since some
of the new anti-HIV drugs may not mix with your old, but still necessary,
medicines. Project
Inform has a list of all the different drugs, their most common
side effects, and some of their serious interactions with other
medications.
As for what will help you stay on the drugs once you start them,
there's no single strategy. But GMHC's former Meals program coordinator
Frank Abdale, working from a document by Marci Fenton, MS, RD, at
AIDS
Project Los Angeles, suggests the following tips for staying
on course:
- Write down your own regular meal and medication schedule.
- Figure out a daily routine of eating and taking medications
that works for you.
- Practice your routine every day.
- If you can't stick to your routine, talk to someone about the
difficulties that are keeping you from doing so. Make some adjustments
and try again.
- Make eating and taking your medications your number one priority.
- Treat your food as another medication.
- Use a timer to remind you when to take your medications and
when to eat.
- Use a pill box with multiple compartments to carry your medications
around.
- Every day, track each medication dose you take and snack you
consume by using a checklist or journal.
- Buy plenty of easy-to-carry snacks that don't spoil easily.
- Keep food within easy reach — at the side of your bed,
next to your phone, on top of the TV, or some other plainly visible
location.
- Put a snack in your bag whenever you leave home for work, appointments,
errands, socializing, walks, a movie, etc.
- Communicate your feeding needs to anyone with a demand on your
time — say, for example, "I need to eat first."
- Set up meals with friends during times you can eat.
© 2003 Gay Men's Health Crisis |
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