Changing HIV treatment

You want your HIV medication to work well. You want the medication to suppress the virus, to cause little or no side effects, and to be easy to use on a daily basis. Many people start with one HIV medication, then switch to another at some point.

In brief:

  • There are several reasons for changing HIV treatment
  • Choose a convenient time to switch
  • Additional monitoring will take place after switching
  • After switching, you may experience temporary side effects that disappear rapidly

When to change HIV treatment?

There are many types of HIV medication available today. Read more here about the different types of medication. There can be various reasons for switching:

  • The medication has a dosing schedule or food guidelines that don’t suit you. It doesn't take much to find a more practical medication.
  • The medication causes side effects. By replacing one or more pills it is possible to find a treatment that has fewer side effects.
  • Your blood level (the amount of medication in your blood) is too low , or HIV develops resistance to one or more types of HIV medication. Resistance means that the HIV medication no longer works properly. The viral load (the amount of virus in the blood) then rises again. Usually there is a good alternative combination of HIV medication available.
  • You’re pregnant or you want to get pregnant. Not all HIV medication is guaranteed to be safe for the baby.
  • You plan to use other medicines or preparations that are a bad mix with your HIV medication. These could be prescription or non-prescription medicines: like hay fever medicine, alternative medicines like St John’s Wort, or party drugs like ecstasy.
  • You may feel more comfortable taking a different HIV medication. For instance, because you don't have to take it with food or because it involves taking less pills.

Find out the cause

If it becomes clear the treatment is not working optimally, it's important you and your doctor try to find the cause. Together you can check for the best course of action. Changing your HIV medication is often possible.

Sometimes your only choice is to switch to another medication: for instance, because the current HIV medication isn't working properly, because of allergic reactions or other side effects. But when you do have other options, you should discuss the benefits, possible side effects and food guidelines of a new medication with your doctor.

What day should you switch on?

It also makes sense to consider when to switch. There is a greater risk of side effects during the first few weeks. This can be annoying if, for example, you've just gone on holiday or you have a busy period at work. You can also consider using up your supply of old pills first.

You may want to change the time at which you take your pills, for example, because there are no food guidelines with the new combination. Or because you want to take the pills shortly before bedtime, so that you have fewer side effects. Switching may give you the opportunity to choose a better time of day. If you switch from taking two pills a day to one, you should discuss with your HIV nurse when to take the last of the old pills, and when exactly to take the new one for the first time.

Do you know the potential side effects?

It's important to know what side effects to look out for. Always report the side effects to your doctor. Inform yourself in advance and read the HIV medication’s patient information leaflet. Don't be alarmed by all the side effects listed there: they hardly ever occur, and definitely never all at once. You really don't have to concern yourself with HIV all the time, but it is good to be aware of the most common side effects.

Many side effects disappear a few weeks after starting HIV medication. Give yourself at least a month to find out how they really affect you. Don’t carry around questions or complaints for too long: feel free to call the HIV nurse if you think you have a side effect. Proper support is particularly important during the transition.

Picking up medication from the pharmacy in time

Some pharmacies have all the current HIV medication in stock, but not all pharmacies do. Make sure you pick up the new pills from the pharmacy before you actually need to start using them. Many pharmacies only order HIV medication when someone comes in with a prescription.

Extra blood monitoring

Extra blood tests and an extra clinical appointment are necessary to check how the switch is going. Was your viral load (= the amount of virus in your blood) undetectable, in other words so low it couldn't be measured? Then it will probably be the same after this first check. Usually the doctor also checks the blood level of the new medication. This involves checking whether there is enough HIV medication in your blood.

If the blood level is too low, the medication is not having enough effect. Then the doctor may decide to increase the dose. If the blood level is too high, you run the risk of side effects. So blood level determination is important for a tailor-made treatment. During the extra check-up visit, you can tell your specialised HIV docter or HIV Nurse if, and whether, you are pleased with the new medication. If your health stabilises after a while, you come back to the hospital for monitoring as often as you used to do.

Talk to someone about changing HIV treatment?

Whether it's changing HIV treatment, side effects of medication and what you can do about it, or other issues – you can get help and expert advice if you ask for it. Or if you just don't know what to do. You can always update your specialised HIV doctor or HIV nurse about this. You can also call the Servicepunt (Service Desk) at the Hiv Vereniging (the Dutch Association of People with HIV): 020 - 689 25 77 – Mondays, Tuesdays and Thursdays, 14.00 – 22.00.



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