Managing your ARVs (HIV treatment)

When to start Antiretroviral treatment and the reasons behind why you should not delay treatment.

When non-adherence to ARVs is a risk to your health.

If you or a loved one has recently been diagnosed with HIV, we have a specially designed series of articles to help you process all the information and emotions effectively so you can live a long, healthy and happy life. Click here to view our support journey.

This article focuses on integrating HIV treatment with the rest of your life. If you have any more questions, we encourage you to speak to your doctor, nurse or clinic team for more information and recommendations. Remember that your body is unique, so your experience with ARVs won’t always be the same as for other HIV-positive people.

When to start HIV treatment

When ARVs were first rolled out in South Africa, the National Department of Health set a treatment criterion: an HIV-positive person would only be prescribed ARVs if his/her CD4 cell count dropped to a level below 350cells/mm3. Today, immediately upon being diagnosed as HIV-positive, medical practitioners in South Africa are obligated to prescribe ARVs.

Many HIV-positive people, upon receiving their diagnoses, enter a state of shock and/or denial. A lot of people will collect the ARVs and not take them as instructed, for up to four weeks thereafter, and others will keep the script aside and delay even collecting the medication. Because of the high emotional and mental impact, it’s very rare for someone to commit to and begin taking his/her ARVs immediately upon being diagnosed.

HIV Treatment Guidelines

When is the best time to take your ARVs?

ARVs need to be taken exactly as your doctor, nurse or clinic team instructs you to do so. This includes the time of day, the relation to meals, alongside the prescribed nutritional plan you may be referred to, and an exercise plan.

How do your ARVs affect your life insurance policy?

We at AllLife help HIV-positive men and women get up to R10million life insurance. One of the qualifying criteria for specialised HIV life cover relates to your CD4 cell count, which can be determined through a single simple blood test. In order to maintain your own health, and the validity of your life insurance policy, your regular blood tests (annual or bi-annual, depending on your use of private or public healthcare) need to reflect a healthy CD4 cell count, which is primarily achieved by adhering to your HIV treatment plan.

What support is available for HIV treatment adherence?

Dr. Avron Urison says that the prescription of medicine is an essential component of the delivery of health care, given its function to not only relieve symptoms or cure conditions but also to prevent poor health in the future. Consequently, there is a need for thorough adherence counselling, so as to guide people living with HIV, particularly in South Africa, on how they can keep HIV under control and lower the risk of developing viral resistance.

Dr. Urison also stated that incorporating a behavioural element to adherence interventions has the potential to increase effectiveness. This is because educational efforts alone are not enough to promote adherence to medication, especially with HIV-positive people stuck in denial, or closing themselves off to learning opportunities.

“Generally, improving how people take their medication has a far greater impact on clinical outcomes than an improvement in treatments,” Dr. Urison said. “In the case of people living with HIV, they need to be helped to understand that missing medication doses regularly, or changing the time medication is taken, enables the virus to defeat the ARVs sooner.”

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What happens when you don’t take your ARVs regularly?

Dr. Urison stated that non-adherence to HIV treatment plans becomes a challenge when people hesitate to talk about their doubts or concerns. There’s a desire to ‘please’ medical practitioners at times, through wanting to look as if medical concepts are clearly understood when it’s in fact not at all the case. People are afraid to feel inferior or stupid, and it impacts their health in a major way.

This is why South African medical practitioners are encouraged to approach HIV treatment from all angles, and encourage conversation with patients or coax information from them by using communication skills, like the use of a warm and inviting voice when asking questions, carefully selecting which questions to ask, and integrating symptomatic knowledge with patients’ responses.

How can HIV-positive people get the support they need?

Everyone in South Africa, but especially HIV-positive people, are strongly encouraged to let their medical practitioners know if speech, learning and physical impairments may be a factor in understanding HIV and what’s required to treat it. Additionally, language barriers in South Africa are being actively addressed, as medical doctors are requested to now learn at least 2 national languages.

Don’t be afraid to talk about what you need, or prefer, to help you understand your own health, and how to look after it.

Intentional and unintentional non-adherence to HIV treatment

Dr. Urison states that there are two categories of non-adherence to HIV treatment: intentional and unintentional.

Intentional non-adherence occurs when an HIV-positive person decides, with full knowledge and awareness of what he/she is doing, not to follow the treatment recommendations.

Unintentional non-adherence occurs when someone intends to follow the prescribed dosage and schedule, but is delayed or prevented by uncontrollable circumstances. Related situations include poor understanding of prescription instructions due to a language barrier, or impairment as we have mentioned above. Equally so, forgetting to take your ARVs counts as a form of unintentional non-adherence.

Sources:
AIDSTruth. 2020. [online] Available at: <http://aidstruth.org/> [Accessed 14 August 2020].

Southern African HIV Clinicians Society. 2020.[online] Available at: <https://sahivsoc.org/> [Accessed 14 August 2020].

The South Africa Health News Service. 2020. [online] Available at: <https://www.health-e.org.za/> [Accessed 14 August 2020].

World Health Organization. 2020. [online] Available at: <https://www.who.int/> [Accessed 14 August 2020].

We all have questions.

Below are some of the answers to the most common questions that you need to know.

What is usually the first sign of HIV?

After getting infected with HIV, most patients only experience moderate flu-like symptoms. Typically, the illness is sudden in onset and is characterised by fever, swelling of the lymph glands, a measles-like rash all over the body and ulcers in the mouth and sometimes on the genitalia.

What are the 4 stages of HIV?

  • Stage 1: Infection – Exposure to infected bodily fluids.
  • Stage 2: Asymptomatic – HIV quickly spreads and the patient becomes seropositive for HIV antibodies.
  • Stage 3: Symptomatic – The immune system is now engaged in a constant battle with the rapidly replicating virus.
  • Stage 4: AIDS – At this stage, the patient’s CD4+ count is 200 cells per mm3 or less.

How soon can HIV be detected by a blood test?

No test can detect HIV immediately after infection. The time between initial infection and a detectable viral load is called the window period. It can take anywhere from 2-12 weeks to after exposure detect whether you are HIV-positive or not, depending on which testing method is used.

How long does it take to show symptoms of HIV?

Following initial infection, there is a period of intense, unchecked viral replication that occurs. It usually takes two to four weeks after infection and can last about one to two weeks, after which there tends to be a slight recovery, and the infected individual is considered to be seropositive for HIV antibodies.

How is HIV transmitted?

HIV is transmitted from one person to another through the exchange of body fluids. The main method of transmission in South Africa is through unprotected sexual activity.

Does HIV test affect life insurance?

Being HIV-positive can affect standard life insurance policies, particularly if your status changes from HIV-negative to HIV-positive within a particular age range. That’s why AllLife covers all lives. Your HIV status doesn’t prevent you from getting cover with us.

Can HIV-positive women have children?

Yes, HIV-positive women can enjoy healthy pregnancies and give birth to healthy HIV-negative babies. Through the Prevention of Mother to Child Transmission (PMTCT) programme has been highly effective in reducing transmission risk to under 1%.

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