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Picking an HIV Treatment for You

Today, there are more highly effective and easy-to-take medication options to control your HIV than ever before. What’s more, many of them are virtually free of side effects. Among them is the latest option, the first long-acting injectable. It currently requires a monthly shot at your provider’s office, after an initial month of daily oral pills. We’ve come a long way from the days when meds were barely effective and then highly effective but often rife with side effects. 

How do you choose which regimen to start on? And if you don’t like it, how do you transition to a different one? Your choice of meds starts with having a great relationship with your HIV care provider. From there, it’s all about open communication.

Take it from Charlene Flash, MD, president and CEO of Avenue 360 Health & Wellness, a nonprofit health system with about 1,000 patients living with HIV, most of them Black and Latino and many of them LGBTQ. “I tell my patients, ‘Our goal here is to have you live a long and healthy life where HIV is an afterthought,’ she says, ‘and where you can focus on your happiness, relationships and life goals.’”

With that in mind, she says, “I’ll generally suggest starting a regimen based on what, if anything, you’ve been on before. I’ll let your genotype drive decision-making.” She’s referring to the results of lab tests that show whether your particular HIV is resistant to certain meds; most newly diagnosed folks have zero resistance and hence can choose from all available options. “I always try to have as simple a regimen as possible.” These days, that often means one of several one-pill-daily regimens that, generally speaking, don’t cause side effects or need to be taken with food.

Want to acquaint yourself with the current options before meeting with your provider? Skim them here. Still scared about starting or changing treatment? Be ruthlessly honest about that with your provider, says Flash.

Charlene Flash, MDCourtesy of Avenue 360 Health & Wellness

“I had a young woman patient with some mental health struggles who was scared to take her meds,” she says. “So I had her get her bottle from the pharmacy, take her first dose with me and sit with me for the first 15 minutes. That’s what she needed. Then I was able to link her with a community health worker who’s also living with HIV.”

Together, patients and providers can dream up other solutions, says Flash. “Sometimes we set an alarm on the patient’s phone to remind them to take their meds. Or I’ll give them a pillbox,” says Flash. “I also suggest that patients link taking their meds to something they already do every day, like brushing their teeth.”

Flash also recommends sharing your status, if you’re comfortable doing so. “Even if there’s only one person you can disclose your HIV status to, consider making them your meds buddy—someone who holds you accountable.”

Above all, says Flash, take a deep breath. In this day and age, it’s almost 100% guaranteed that you’re going to find an easy-to-take regimen that keeps HIV undetectable in your bloodstream and keeps you healthy so you can focus on the things you care about. 

“I always start with patients by saying, ‘I’m going to teach you many things today.’” Such things include explaining terms like CD4 cells, which HIV meds help to keep robust so you have a normally functioning immune system, and viral load, which HIV meds push to undetectable so HIV is barely circulating in your system, which in turn means you can’t pass on the virus sexually to others.

“But,” continues Flash, “I always say, ‘The one thing I want you to leave with here today is that if we partner together on you taking your meds, you’re not going to die from this. It’s not the 1980s anymore.’”

That’s why it’s worth putting in the time both alone and with your doctor to consider all the med options available to you today. There are a lot, and a good handful of them give you multiple pathways to living with HIV free of illness, infectiousness and anxiety. So jump into the process with your provider. You’ve got a life to live!