The effect of HIV treatment

Medications that fight HIV are known as HIV inhibitors, because they inhibit or prevent the virus from replicating. The medications will strengthen your immune system and your body will recover. You will not be cured of HIV, but it will soon become a “chronic infection” that you can grow old with. The goal of the treatment is to reduce the amount of HIV in your blood (the so-called viral load). Your HIV specialist will prescribe three or more HIV medications for you. There are also 3-in-1 pills. Fortunately, any side-effects you may have are often short-lived. If the side-effects don't go away, you can always switch medications.

Despite your being treated with HIV medications, as an HIV-positive gay man you will have a greater chance of getting STIs such as Hepatitis C, LGV and syphilis. Do you have multiple partners? Get yourself tested for STIs every three months and get tested for Hepatitis C at least twice a year.

Even though you are receiving treatment for HIV you will also still have a greater chance of getting a number of other diseases and infections. Your HIV internist will keep an eye on everything so that he or she will be able to act in time, if necessary.    

Recreational drugs don't seem to have any negative effect on your treatment. On the other hand, some HIV medications will reinforce the effect of certain drugs. That will increase your chances of having an overdose.

Keeping your immune system strong

HIV is a virus that weakens the immune system. As time goes on, your body becomes less and less able to defend itself against infections and diseases. You can keep your immune system strong by getting treated with HIV inhibitors. This treatment is called “antiretroviral therapy” (ART).

Chronic infection

Treatment will not cure you of HIV. Bits of the virus will always remain in your body. The HIV inhibitors will nevertheless help to suppress the virus and keep you healthy. You will have more or less the same life expectancy as other people your age who are not infected with HIV but have the same lifestyle in terms of things like your diet, whether or not you smoke and how much exercise you get.  

In other words: thanks to the medications, your HIV infection will become a chronic condition that you can grow old with.
Undetectable viral load

Someone who is not being treated for his HIV has thousands if not millions of virus particles (copies) in every cubic millilitre (mm3) of his blood. The goal of the treatment is to reduce the amount of HIV in your body (i.e. your viral load) until the virus can no longer be measured. If the amount of HIV in your blood is no longer measurable, your viral load is undetectable.  Undetectable means that you have fewer than 50 copies of the virus per cubic millimetre of blood.  

Combination therapy

To get your viral load to go down, your HIV internist will prescribe three different HIV inhibitors for you to take. For that reason, the treatment is also known as a “combination therapy”. There are different types of inhibitors, each one inhibiting HIV in its own way.

The number of CD4 cells increases

Your viral load will normally drop below the level of detection within a few weeks or months (and in any case within half a year) after you start treatment. From that moment on, the number of your CD4 cells will rise, and your immune system will grow stronger again. An additional advantage of having an undetectable viral load – and this is an important advantage – is that it will practically eliminate your chances of transmitting your HIV to others.  

Successful treatment

A combination therapy is successful if: 

  • your virus becomes and remains undetectable
  • your immune system is strong enough to allow you to live a healthy life  
  • any HIV-related symptoms you have become less severe.

The treatment will only be successful if you take your medications at the same time every day. By complying with the therapy, you will prevent your HIV from becoming resistant to the treatment you are taking.  

Many people with HIV say their treatment affects their quality of life only very little if at all. More than half of the people with HIV give their health a score of 8 (out of 10) or higher Fewer than one out of ten people with HIV consider their health to be “unsatisfactory”.

Side-effects

It is possible that some HIV medications will have side-effects.  Most side-effects will disappear quite soon. Are you having continuing problems with a particular side-effect? In that case, switch medications in consultation with your HIV internist. That is possible without any problems. Most men with HIV manage to find a combination of HIV inhibitors that will cause few if any problems.

Greater chance of getting STIs and other disorders 

Despite your treatment, you will still have a greater chance of getting certain conditions. You will have more chances of getting certain STIs, for example, or a greater chance of developing conditions that normally only affect the elderly. Doctors refer to the latter phenomenon as “premature ageing”. As someone who is HIV positive and receiving treatment, you still have a greater chance of getting:

  • Hepatitis C, LGV and syphilis 
  • pre-stages of anal cancer
  • osteoporosis
  • cardiovascular diseases
  • kidney problems
  • depression

It is not known why you can get STIs like Hepatitis C, LGV and syphilis more easily if you are HIV positive. Some scientists think that HIV weakens the immune response in your intestinal membranes from the very beginning, and that it never recovers, despite the otherwise effective HIV medications. In other words, your intestinal membranes probably remain defenceless against all kinds of infections. Do you have multiple partners? In that case, get yourself tested every three months for all STIs and at least twice a year for Hepatitis C if you run a risk of getting that.

Your HIV internist will keep a close eye on you with regard to all of the conditions mentioned above.  If any health problems should arise, you have will have the advantage of being able to deal with them early on. You can get treatment or start taking medications against those conditions in good time.  

The impact of drugs on HIV medications

Little is known about the impact of recreational drugs on HIV medications. Drugs do not seem to have any negative impact on your treatment. On the other hand, drug use can lead you to forget to take your daily medications. Some drugs, such as crystal meth (“Tina”), speed, MDMA and XTC, dry out the mucous membrane in your anus. As a result of your dehydrated membranes, you will have a greater chance of getting STIs such as Hepatitis C.

Greater chance of an overdose

The other way around: some HIV inhibitors will actually strengthen the effect of party drugs and sedatives. In particular, the effects of XTC, MDMA, GHB, GBL, ketamine, speed and crystal meth will become stronger. That will increase your chances of having an overdose. In particular, so-called protease inhibitors and efavirenz are HIV medications that are known to have such a reinforcing effect. 

 

 

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