Anti-retroviral Therapy (ART) medicines are the life-line to living with HIV!
At the recent International Conference on HIV in Washington DC (USA) it was said that a person with HIV in Uganda who is 35 years old now – and has a CD4 count of higher than 100 – and starts on ART and takes it faithfully is now expected to live for more than 35 years!
That means that taking ART regularly can allow you to live just as long as you would expect to live if you did not have HIV. This is great news! And we are not talking about living in the ‘advanced western countries’ – the Uganda estimate is for a country with a health system and standard-of-life situation similar to what we have in India!
But did you notice that in the second paragraph we highlighted 4 words: and takes it faithfully! If I have HIV and I do not take the medicine very, very, very regularly…. well, then it just won’t work!
This is what we call ‘Adherence’.
It means being able to take the medicines you have been prescribed completely!
All the drugs – at the right dosages – at the right time – and in the right way!
No missing doses!
If I have HIV and I take my meds properly – then the amazing immune system God has given me can be rebuilt. My body can fight off all the other diseases that are trying to bring me down.
But if I do not take the medicines properly – well – then the medicines will stop working. Period.
There are other sicknesses like diabetes – where if I miss some meds then I can compensate by increasing my doses later. HIV does not work that way. If I miss my meds – then I am giving the virus a free ride to become resistant to the meds.
Take a look at these pictures. They illustrate what happens in the body of a person with HIV who is taking their ART meds twice a day.
If the person taking ART is regular – taking their medicines at the same time each day and not missing a dose, then this is what takes place:
After a person takes their morning dose at 8 AM, the level of the drugs in the blood increases till about 2 PM, after which they start to drop. But they never go down to ‘zero’ because at 8 PM, the next dose is taken and the level of drugs increases again. The pattern is repeated the next day.
The most important aspect is this – by regular taking of ART at the right time each day, the level of drugs in the blood never drops below the ‘Threshold of Viral suppression’ (shown in the picture in yellow). This means there is always enough drug available to suppress the HIV. You suppress the HIV – and it can’t reproduce!
That is why good adherence to ART medication should result in the person with HIV having no detectable HIV in their blood!
That’s great news! It means that the bodies CD4 cells are then able to replenish themselves – and the overall immune function can improve – leading to a restored immune system! And we are seeing this happening over and over again. People on ART who are taking their meds properly – are getting so, so much better. Are able to work again. Are living to see their children getting married! Amazing stuff!
But all of this depends on taking the medicines in the right way – faithfully!
Here is what happens if the ART meds are not taken regularly.
In this case, the person took a dose at around noon – and then the next dose the next day at about 5 AM.
As you see in the picture above, from 8 AM to noon there are no ART drugs circulating in the person’s blood at all – because they have not taken their meds. Even when around noon they take their dose of ART – it still takes about an hour for it to come to a level where it will suppress the HIV virus.
So from about 2 PM the ART is now able to suppress the HIV virus – the levels increase till about 6 PM, when they start decreasing again. Around 12 AM the levels of ART dip below the minimum threshold needed to suppress HIV. From now on the HIV can multiply again. And the next dose is only taken at 5 AM, which means another hour or two before the minimum threshold is reached.
So what does the HIV do in a person on ART who is not taking his or her meds regularly? It does this:
As you can see – whenever there are no ART drugs circulating in the blood – the HIV is reproducing. More HIV means more attacks on the CD4 cells.
And even more importantly – when the ART drug is present in sub-optimal levels – the HIV that is reproducing at that time can become drug resistant.
This is why some people who are being treated on ART experience drug failure. They have opened up doors for the virus to keep reproducing even though they are taking ART meds. Sadly – some of them allow their HIV to become resistant to the ART meds.
The shocking thing is this – even people who think that they are taking their meds regularly may be opening up the gates for HIV to reproduce.
Take a look at this chart.
What you see is the percentage of people with ‘undetectable viral loads’ (which is what good ART should achieve – as against how regularly they take their ART meds:
If you see the first column you can see that 80% of people who are taking their ART over 95% of the time – achieve an ‘undetectable viral load.’
But here is the shocker – even people who are 90-95% adherent – only half of them achieve an ‘undetectable viral load.’
And for people who are less regular … well the figures show that most of them won’t reach the goal of suppressing their HIV.
My dear friend – if you are reading this and you have HIV – please do take your ART faithfully!
It is such a gift to be able to have these meds! They can take you well into old age. You can become old – just like all your friends and relatives who do not have HIV expect to get old. But they will only work if you take them very, very, very regularly.
You have to achieve an adherence rate of over 95%. That means that if you are taking your meds morning and evening – you have to miss less than 3 doses in 3 months!
Remember – the key to your long life is in your hands. Those ART tablets are a gift from God. Take them. Regularly. We want to see you live. And we all want to see you live long and healthily!
If you are reading this and you have a friend or relative who is HIV positive – please do encourage them to take their meds. It is often a challenge to take the meds regularly. No one likes to take pills – and that too life-long! But if your loved-one does take their meds – and takes them regularly – then they can have a long life!
Your part in encouraging and helping out your loved one is vital.
Be there for them. Keep positively talking about the need to take the meds. Pray with them. Find out when their next ART appointment is. Offer to go along with them to the doctor. Tell them how valuable they are. Show them you care by being with them through the thick and the thin of things!
We all need each other. ART meds are a great gift from God – but are not always easy to take. But once we start on them, we have got to keep taking them. If we take them regularly… then we can live looooooong!
Don’t stop! Keep taking your meds! And make sure you take your meds faithfully!
We want to see you old!
——-Note: Much of this post was taken from “Adherence and ART” the excellent powerpoint presentation put together by the Harvard Medical School HIV Initiative in Vietnam. This can be downloaded by clicking: here