SEPTEMBER 1998

NUMBER ONE

Love Thyself
It's tough to fight HIV. Get help to face the dragon and create a way that works for, not against, you.

Everyday, it seems, we hear more news about HIV-some good, some bad, and much of it confusing. With so many drugs and combinations being used to treat HIV, it's hard for even the experts to come up with hard, fast rules you can follow. It's even more difficult for many to get access to high-priced protease therapies. The best advice comes from those living with HIV: Empower yourself. Information can help you make good treatment decisions and know what to expect as you plan for your future. Read up on the news, talk to your doctor, and reach out to others living with HIV. They can help you come up with an approach to fighting AIDS that's designed to work for you, not against your.

Experts do agree on one thing: An integrated quality-of-life approach to HIV care is one that focuses on preventing illness, stopping HIV, and keeping people healthy day in and day out. Antiviral therapy is only one part of the picture. While these drugs can stop HIV, they're also hard to take and can cause side effects. Your best bet is to seek medical care from a doctor with experience in HIV care who will work closely with you to find a therapy that is strong enough to stop HIV but not too hard for you to manage. The rest of the picture sounds like advice from Mom: Try to eat well, take a daily multi-vitamin, get enough rest and sleep, exercise, and reduce your stress (see "Give Yourself a Complement").

Add to this list regular doctor's visits, gynecological screening and Pap smears for women, STD and hepatitis prevention, recommended vaccinations and seasonal flu shots, and a harm-reduction approach to recreational drugs, alcohol, and cigarette smoking that weaken your immune system. (see "Play Your Hand").

Antiviral Therapy: The success of HIV combination drug therapy has led to new federal treatment recommendations that are constantly being revised as new drugs and studies emerge (see accompanying tables). Federal data shows a three-drug combination (also called HAART-Highly Active Anti-Retroviral Therapy) can reduce HIV activity to below detectable ("undetectable") levels in blood plasma and provide a clinical benefit by increasing T-cell counts, improving immune function, and preventing the onset of HIV-related opportunistic infections (OIs). For people with advanced HIV disease, HAART can reduce by 50 percent the chance of developing an OI and is associated with extended survival. Clinical studies show that even a partial reduction of HIV activity is better than none at all (see "HIV Illnesses").

Unfortunately, many people are not benefiting from the new HIV therapies, which can be very toxic. A drug regimen may not be powerful enough to stop very strong strains of HIV or may be too hard to take for a variety of reasons: difficult drug schedules, side effects, poor absorption of the drugs, intolerance, negative drug interactions, and HIV drug resistance (see "When Drugs Fail"). If your drug regimen isn't working or is too toxic, don't simply quit: Talk to your doctor about an alternative course of treatment that can work for you. There are supplements you can take to counter the negative effects of HIV drugs and replace lost nutrients such as zinc, B vitamins, and selenium.

Physicians are urged to work closely with patients, keeping in mind prior HIV-treatment history. Topics for discussion: barriers to adherence including poverty and lack of insurance; attitudes toward illness and health management; helpful support systems; frank discussions of recreational drug and alchohol use; and the importance of diet, nutrition, and exercise.