infections
Antiretroviral Treatment of Human Immunodeficiency Virus (HIV) Infection
Use of antiretroviral medications
Antiretroviral treatment is beneficial only if the medications are taken on schedule. Missing doses allows the virus to replicate and develop resistance. Treatment cannot eliminate the virus from the body, although the HIV level often decreases so much that it cannot be detected in blood or other fluids or tissues. An undetectable level is the goal of treatment. If treatment is stopped, the HIV level increases, and the CD4 count begins to fall. The best time to start antiretroviral treatment is as soon as possible, even if people are not sick and their CD4 count is still above 500 (normal is 500 to 1,000). Doctors used to wait until the CD4 count was below 500 to start antiretroviral treatment. However, research has shown that people who are promptly treated with antiretroviral medications are less likely to develop AIDS-related complications and to die of them. Before starting a treatment regimen, people are taught about the necessity of the following: Taking medications as directed Not skipping any doses Taking the medications for the rest of their life Taking the medications as directed for a life time is demanding. Some people skip doses or stop taking the medications for a time (called a drug holiday). These practices are dangerous because they enable HIV to develop resistance to the medications. Because taking HIV medications irregularly often leads to drug resistance, health care practitioners try to make sure that people are both willing and able to adhere to the treatment regimen. To simplify the drug schedule and to help people take the medications as directed, doctors often prescribe treatment that combines two or more medications in one tablet that can be taken only once a day. Doctors may stop treatment temporarily if people develop another disorder that requires treatment or if side effects are severe and doctors must determine which medication is causing them. Stopping treatment is usually safe if all medications are stopped at the same time. Medications are restarted once the dose of the medication causing problems has been modified or another medication is substituted for it and doctors determine that it is safe to restart treatment. An exception isabacavir. If people have had a fever or rash when they were takingabacavir,abacavirshould be permanently stopped. Such people may have a severe, potentially fatal reaction toabacavirif they take it again. 