Living with HIV in the Philippines: Preparing for the ARV's

Your first steps have been accomplished: the HIV test, the labs and the CD4 (and VL if prescribed). The HIV doctor then recommends that you need to start with your ARV's. In a few days, your HIV treatment will start. You then ask yourself if you are ready for it? You then get scared once again, like when you got scared when you first received the HIV confirmatory test. Once again, you get confused and restless.

I have been doing online counselling for a year now and this period of pre-ARV treatment is very crucial. PLHIV's should be well informed about adherence to ARV's, the monitoring of signs and symptoms, the importance of the trial period, the different lines of treatment regimen. For one to be prepared physically and emotionally we have to discuss the ARV treatment process and what to expect during each step.

A. ARV ADHERENCE

1. WHAT IS ADHERENCE?

For HIV treatment to be effective, good adherence means taking all your ARV medicines, every day, at the right time.

Good adherence is important with most medicines, but it’s absolutely vital with antiretrovirals.

When we start taking antiretrovirals, we stop HIV from making copies of itself. This gives the immune system a chance to recover.

- As the viral load goes down, the number of CD4 cells goes up. When our adherence is good and our antiretroviral treatment is working, our viral load can become 'undetectable'. Undetectable does not mean the virus has gone. It just means that the amount of virus in our blood is too small to be measured (less than 50 copies per tiny drop of blood).

When you start ARVs, you take a combination of at least three different ARV drugs. Sometimes this is called triple therapy or HAART (Highly Active Antiretroviral Therapy). The three drugs together form your ARV regimen. The first ARV regimen that you will take will probably be Nevirapine, 3TC and d4T (or Efavirenz instead of Nevirapine).

2. WHY GOOD ADHERENCE IS IMPORTANT

If your adherence is bad, the HIV in your body becomes drug-resistant (it learns to fight the drugs).
ARVs stop HIV from making copies of itself. Taking our pills on time is important because if we miss a dose, the virus immediately takes advantage and starts to replicate itself again. These copies will be a little bit different and the ARVs will be less effective against this changed virus.
With HIV, avoiding resistance is very important. The only way to treat drug- resistant HIV is to move on to a different combination of ARVs. We call this a new regimen. In South Africa at present, there are only two regimens available in the public sector.
HIV that is resistant can be passed on to someone else and the drugs will not work for that person either.

3. PREPARATIONS:

Read everything about adherence and it's implications to ARV treatment
Prior to taking ARV's, be ready with your timers and alarm clocks
Buy pill boxes either a 1 week-pill box or a 1 month-pill box
You can practice by taking vitamins or drinking a juice drink everyday at the same time
Be ready with a notebook or use the "Note pad" in your iPad for monitoring of missed doses or late doses. This is in preparation for your initial reporting to your HIV doctor during consultations
Be sure to get the phone number of your HIV doctor so you will know what to do in case you got confused with the timing of your ARV's
Adherence can be influenced by depression, not having disclosed the HIV status, using alcohol or drugs. If you any one of these issues, you need to consult your doctor for possible referral to a psychologist, a psychiatrist or a counsellor,
Adherence can be compounded by issues like, sometimes clinics and hospital run out of ARV's and long travel to the clinics or hospital to get ARV's. Make sure that you are ready to drive or commute and set aside time for these. A PLHIV should also make sure that 2 weeks before running out of his supply, he should get a refill of his ARV's. In case there are no supply, be sure to coordinate with the HIV doctor or the treatment for possible borrowing or ARV's from other PLHIV's.

B. MONITORING OF SIDE EFFECTS

1. Importance of monitoring the Side Effects of ARV's

The ARV's can have side effects for different PLHIV's. One might not even have adverse effects but to others, there will be pronounced effects.
Side effects can be hypersensitivities or may also be damaging to organ systems and functions

2. PREPARATIONS:

Get a notebook or use your "Note Pad" in your ipad and monitor the effects of the ARV's from day 1. Note any changes in your body or any observations by people around you and be ready to report them immediately to your doctor.
Make sure that you have your doctor's phone number with you in case you observe any effects of the ARV's or any changes that you feel or you see in your body.
Make sure to go and get a consultation with your doctor when needed.
Be ready with your health card, credit card or emergency fund in case the doctor recommends hospitalisation.
If you already disclosed your status to your family and friends, make sure that they help you with the monitoring of the side effects. They need to be your partners in monitoring these effects.
Take pictures of the physical side effects of the ARV's. This is helpful in presenting them to your HIV doctor during consultation.

C. TRIAL PERIOD

1. WHAT IS THE TRIAL PERIOD?

The trial period is the period wherein you initially take your dose of the ARV's
Usually the trial lasts for a minimum of 2 weeks. This gives time for the ARV's to produce any side effects if any

2. PREPARATIONS

Get a notebook or use your "Note Pad" in your iPad and monitor your daily routine, from type and amount of food and beverage intake, sleeping habits, exercise routine, temperature of the day or weather, other medicines taken, etc.
Monitor the date of initial intake of ARV's to date of the appearance of side effects if there are any.
Make sure you have your HIV doctor's number ready for possible phone discussion
be prepared that during the trial period, avoid eating seafood and poultry products.
Be prepared to drink more than 8 glasses of water to flush out toxins in your body
During the trial period be prepared not to take any medicines without the knowledge of your HIV doctor

D. LINES OF TREATMENT REGIMEN

1. There are three lines of treatment to HIV.

The HIV doctor will initially prescribe you cocktails belonging to the first line. Your doctors will switch ARV's if there will be side effects during the trial period
When all the combinations have been tried and still there are side effects, the second line cocktail will then be prescribed
When there are side effects on the second line, after trying all available combinations, the last or third line will be prescribed. In the Philippines, there are no available third line so the HIV doctors try as much as possible to put the PLHIV on either the first or the second line of treatment.
Be informed that if the first and second lines of treatment don't work, the option is to purchase your ARV's outside the Philippines.

2. PREPARATIONS

Be knowledgeable about these lines of treatment
Know all options and always partner with your doctor especially when switching cocktails
Be emotionally prepared that there is a possibility that one cocktail might not work for you
Be emotionally prepared that there is a possibility that you will switch cocktails
Read the literature in every ARV prescribed and discuss with your doctor if you have concerns

E. MORE TIPS IN GETTING READY FOR ARV TREATMENT

Read. Empower yourself with all the information about the HIv treatment process.
Always ask your doctor. Partnering with the HIV Doctor empowers you to understand the entire process and sets expectations for both
An immune reconstitution inflammatory syndrome (IRIS) may occur in which while the immune system is recovering, a PLHIV may have aggravated illness from opportunistic infections. Read about this so you will know what other possible scenarios might happen.
Be prepared to be vigilant with the possible side effects of ARVs and IRIS.
Always coordinate with your HIV doctor
Get the number of your HIV doctor
Plan to eat a well balanced diet
Plan to drink more than 8 glasses of water to flush out toxins
Plan to seek the help of those who you have disclosed your status with especially if you need to be brought to the hospital for consultation or possible confinement
You can plan an exercise program. Mind and body exercises like yoga and tai-chi are good ways to relax and rejuvenate the body and spirit.
Always stay positive. Believe that the ARV's will work for you!
If you feel scared and stressed, plan to coordinate with a counsellor, a psychologist or a psychiatrist.
Plan to stop all vices while on ARV Treatment. Avoid smoking, drinking and doing drugs
Plan to rest for 8 hours or more
Plan to affirm to yourself that the ARV's are there to help you and you should not be scared of them.

Friday, February 15, 2013

Preparing for the ARV's