Six Must-Ask Questions for Your Provider When Starting a New HIV Medication
If you’ve been living with HIV for a while, or even if you’re newly diagnosed, you probably know that there are a multitude of HIV medications—antiretrovirals—on the market. By my last count, there were 37 different antiretrovirals approved by the Food and Drug Administration in the U.S. There’s no “one size fits all” drug out there.
Some people may take the first combination of HIV medications they’re initially prescribed for many years. The reason we need so many treatment options is because some people need to switch medications because of side effects, interactions with other medications, or because the HIV virus becomes resistant drugs that are already being taken. Also, HIV treatment options continue to improve, so sometimes it makes sense for people to switch medications if they can take fewer pills or medication that are even safer.
Any time you start a new HIV medication, whether you’re just beginning antiretroviral therapy (ART) or have been on ART for years, there are a few key things you should take the time to investigate. Your provider should give you this information straight away—but if not, make sure you ask him or her to fill in the blanks. Doing so will make you a better advocate for your own health now and in the years to come.
1. How does this HIV drug work?
HIV drugs work by stopping the virus from making copies of itself—or replicating. In order for HIV to replicate, it must infect a human “host” cell, and then use that cell’s machinery to create copies of itself.
Different HIV drugs block HIV replication at different stages of this process of the virus’ life cycle. That means your new HIV drug, belongs to one of these four “families,” or classes, of HIV medications, and works by either:
1. preventing the virus from entering human cells (entry inhibitors);
2. preventing a process called “reverse transcription,” so the virus isn’t able to make a DNA copy of its genetic material (nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs);
3. preventing the virus from inserting its genetic material into the DNA of the human cell (integrase inhibitors); or,
4. preventing the assembly of new viral particles (protease inhibitors).
Usually, we use at least three HIV drugs from at least two drug classes to treat a person living with HIV. Sometimes, two or three drugs that work differently are “co-formulated” in one fixed-dose combination pill. You should find out which type, or class, of drug your new pill is—or if it’s a combination of two or more different types of HIV meds.
2. How do I take this drug?
Some drugs have to be taken with food, others on an empty stomach. For some drugs, it doesn’t matter. Sharing your meal schedule with your HIV provider will help both of choose the right combination of drugs that are right for you.
3. What side effects can happen with this drug?
If you read all of the possible side effects for a new medication, you might feel overwhelmed. Researchers determine all the potential side effects of a new medicine by having people taking the drug in a clinical trial write down every symptom they have while taking the medication. Then, the researchers compare those symptoms to the symptoms that people taking placebo (an inactive substance) report. That means if people taking the active drug report headaches more frequently than people taking placebo, “headache” will be listed as a potential side effect.
However, that doesn’t mean that you will get a headache if you start taking the medication. You might not get any side effects at all. Plan to give your body at least two or three months to adjust to any new medication. Having your providers tell you ahead of time what side effects are more likely to happen than others will give you an idea of what to watch out for. Don’t be afraid to check in with your provider about any symptoms or side effects that concern you.
4. What are the long-term risks with this medication, and is there anything I can do to counteract any negative effects?
In general, there are way fewer long-term risks associated with all the HIV medicines we have today than the long-term risks of untreated HIV. Even so, find out from your provider what the long-term impacts of your new HIV medication might be on your body. HIV providers always keep an eye on liver and kidney functioning of people taking HIV medicines—that’s one reason we ask you to come back at least every six months for blood tests even if you feel fine.
Also ask your provider if there’s anything you can do to counteract potential long-term risks of the medication. For example, if a medication carries a risk of bone density loss, you can do things like stop smoking, take a calcium and Vitamin D supplement, and begin weight-bearing exercise that will help improve your bone density.
5. Does this medication interact with any other medicines, supplements or herbal treatments I am taking?
Ask your provider about possible drug interactions—especially if you’re taking an HIV regimen containing ritonavir (Norvir) or cobicistat (Tybost), since both of these drugs have many potential drug interactions. Even things you buy over the counter, like St. John’s Wort, antacids and vitamins, have the potential to interact with your HIV medicines, so you should always tell your provider about any new medication, supplements or herbal treatments you are taking or want to start taking.
6. What are the alternatives?
The HIV drugs we have today are very good at fighting the virus. We choose between them to come up with the best combination for every individual by taking into consideration results from lab tests, other health conditions the person may have, other medications they’re taking, lifestyle factors, the person’s schedule, and any evidence of drug resistance.
For most people, there are options to change to a different regimen if there are severe side effects or toxicity. HIV treatment is always improving for the better so it sometimes makes sense to change to a new medication regimen. That means it’s okay for you to ask your provider, “are there any other options?”
Joanna Eveland, MD, is an HIV treatment specialist in San Francisco. She oversees HIV and homeless services as the Clinical Chief for Special Populations at the Mission Neighborhood Health Center, is a faculty member at the University of California, San Francisco Clinician Consultation Center, and leads a bi-monthly health education group for HIV-positive men through the San Francisco AIDS Foundation. Dr. Eveland received her M.S. and M.D. at the University of California, Berkeley-UCSF Joint Medical Program and completed her residency at the Contra Costa Family Medicine Residency Program.