Ever hit a restaurant with a menu bigger than your apartment? You need food, but the choices are staggering. HIV drugs are similar. Current information empowers consumers to make "informed" choices when choosing HIV drugs.
Here's shorthand for the five different HIV drug classes from which "combinations" are selected: two types of "nukes" (nucleoside and nucleotide reverse transcriptase inhibitors), "non-nukes" (non-nucleoside reverse transcriptase inhibitors), protease inhibitors, and fusion inhibitors. Combinations should include at least three different drugs. For initial therapy, the Federal Government recommends certain "preferred" drugs for a combination of either two nukes plus a protease inhibitor or two nukes plus a non-nuke.
In chart form, you'd see 23 choices of medicine made from 19 different compounds. (The additional choices are actually combinations of two or three of the 19 compounds. Although there are 23 meds, the number of effective combinations that you can choose is limited. Therefore, you'll want to choose drugs that will not only reach your goal of undetectable as fast as possible, but that will keep HIV as low as possible for as long as possible. That's also exactly what the new Federal Guidelines stress: "Treatment goals should be maximal and durable suppression of viral load."
As far as side effects, all HIV drugs can cause them. But the fewer and milder the side effects, the better. Keep in mind that this is a very individual thing. Side effects vary from drug to drug, and even among different individuals taking the same drug. So consider your lifestyle. For example, if you have a job where you have to be mentally alert, drugs that make it hard to concentrate may not be right for you.
There are also the issues of food requirements. Some HIV drugs have food requirements which means they are taken with or without food, or with particular types of food. Some drugs have easier food rules than others. For example, some nukes have no food restrictions, but others must be taken with meals. Non-nuke drugs have no restrictions. And depending on the drug, protease inhibitors are taken with or without food. Some HIV drugs have no food restrictions and are taken at meal time, almost like a built in reminder when to take them. But having to take one drug with food and another without food can be a hassle. With or without food requirements, the main goal is to pick drugs that will keep your VL as low as possible for as long as possible.
Resistance to your HIV meds means your drugs can no longer fight off the virus. This can happen if the HIV virus evolves in such a way that it enables new copies of itself to survive in the presence of the drugs you're taking. Missing doses can result in the amount of medicine in your blood dropping below levels needed to control the virus. Uncontrolled, the virus will then be free to invade infection-fighting CD4 cells. As more and more CD4 cells are destroyed, you are much more likely to develop opportunistic infections. This "chain reaction" concerns the Federal Government, which notes that "missing one [once-daily] dose may result in inadequate drug exposure over a defined period of time leading to a higher probability of development of drug resistance."
To avoid resistance, research indicates HIV drugs must be taken 95 percent of the time. Even if taken 95 percent of the time, some people still develop resistance. And even with less than perfect adherence, resistance doesn't always develop. The point is that some HIV drugs are "more forgiving" and others "less forgiving" if you miss doses. Try to pick drugs with a good track record at keeping HIV undetectable and avoiding resistance.
Frank Pizzoli writes frequently for Body Positive, and also contributes to Instinct, POZ, and New York Blade News. He founded the non-profit Positive Opportunities (PosOps@aol.com), which offers educational seminars and benefits counseling to HIV-infected people through support from Broadway Cares/Equity Fights AIDS and the Greater Harrisburg Foundation.