What combinations are best?

There are lots of possible combinations of HIV drugs. It’s not possible to describe them all in this booklet. Further, people will respond differently to the same combinations, for a variety of reasons. Just because something worked for a friend doesn’t mean it will work for you, and vice versa. There are many factors affecting individual responses to HIV and therapy.

Some drugs can’t be used in combination for scientific reasons (e.g. they compete with each other to get absorbed into the body), or they have the same side effec profile.

Work with your doctor to choose the best drugs, considering some of the factors listed below:

• What stage of disease are you at (viral load [1]A measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma., CD4 counts, symptoms)?
• What prior treatment, if any, have you had?
• What other treatments are being taken now?
• How easy will it be to take the particular combination?
• What are the possible side effects?
• Do you have a busy life and eat at different times every day?
• Are there confidentiality issues around taking drugs regularly?
• Do you travel a lot?

Australian HIV treatment guidelines are updated regularly and may contain recommendations about which drugs or combination of drugs to take in particular circumstances based on the latest evidence. These are available from the AIDS Councils and PLWHA groups, see Services [2].

Monitoring and changing combinations

You may need to change your treatments for a number of reasons. If there are sudden unexplained changes to your viral load, it could mean that the virus [3]A small infective organism which is incapable of reproducing outside a host cell. has become resistant [4]HIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. to one or more of the drugs in your combination.

You may also need to change combinations if you are unable to meet the requirements for dosing schedules, or if you are finding the side effects intolerable, even if your viral load and CD4 levels are OK.

If you have been experiencing severe side effects due to a particular drug or class of drugs there may be other combinations that do not include this drug or classes of drugs that can be recommended. It is important that you speak with your doctor before stopping any of your HIV antiviral [5]A medication or substance which is active against one or more viruses. May include anti-HIV drugs, but these are more accurately termed antiretrovirals. treatments.

You will need to be monitored after each change in combination to see how the new combination is working. During these times, you will probably need more frequent viral load tests.