NAPWA

Treatment options are different depending on whether or not you have taken ARVA medication or other substance which is active against retroviruses such as HIV. before, so this section will be split into information for women who have never taken treatments (called ‘treatment naive’ women) and women who have taken treatments (‘treatment experienced’ women).

These guidelines are based on available evidence to date and upon expert opinion, which balances the need to start treatment before irreversible damage to your health occurs (in the form of an opportunistic infection or cancer) with caution about exposure to unnecessary side effects.

* The current Antiretroviral Guidelines in use in Australia state that all decisions regarding initiating therapy in an HIV-infected person should be made on the basis of prognosis, as determined by the CD4 T cell count and level of the HIV viral load, the potential benefits and risks of therapy, and the willingness of that person to accept therapy.

** Research data from observational cohortIn epidemiology, a group of individuals with some characteristics in common. A cohort study is a special kind of clinical trial which looks at a treatment or treatment strategy in a cohort of people. studies show that at any given CD4 cell count, those with HIV viral load greater than 100,000 have a higher risk of progression to AIDS and this risk also increases with increasing age. Hence, starting therapy could be considered at a CD4 count more than 350 when these factors and others (the tolerability and long-term toxicity of the antiretroviral regimen and the person’s willingness to maintain a high level of adherence to lifelong therapy) are taken into account.

There are a few key things to keep in mind when you are making decisions about treatment:

• Treatment side effects and dosing schedules are not nearly as difficult as they were when ARV was first introduced. Your doctor should be able to find a combination of drugs that is easy to take without significant side effects for you.
• To protect your immune system and prevent the risk of opportunistic infections you need to keep your CD4 count above 200;
• There is likely to be an advantage in starting treatment when your CD4 count is around 350 rather than letting it drop closer to 200;
• For women with high viral loads – above 100,000 copies, it may advisable to start treatment even if your CD4 count is 350 or above;
• The first few weeks on new ARV treatments can be the most difficult. Your doctor should tell you what to expect, and you may need childcare, help in the house or time off work.

If your health is such that you are considering treatment but you have the option to start or defer, consider your options in the light of the multiple responsibilities (like work, a family, a household) that you may have. Setting aside time to learn about your options, talking about different approaches with a trusted doctor, counsellor or positive woman and thinking about the timing of any change, depending on what is happening in your life, can help you to manage changes in a positive, timely manner.

If you are starting HIV treatment for the first time ask your doctor to help you choose:

• A combination that will suppress viral load (potent drugs);
• A combination that will not limit your future treatment choices;
• Drugs that work well together;
• Drugs with side effects you can cope with;
• A combination that suits your lifestyle.

If you are considering pregnancy in the future it’s a good idea to discuss this with your doctor now, as it is likely to affect which drugs you choose. The vast majority of women with HIV in developed countries who become pregnant on antiretroviral therapy have healthy babies, but there are specific HIV drugs recommended (and some to avoid) during pregnancy.

Treat Yourself Right