Treat yourself right: Treatment and HIV specifics
" 

My little sister died in 1990 and my mom died in 1995. I moved in with my mom's best friend. She took me to the doctor's and they said, 'Nina, do you know what your mother died from?'

And I said 'Yes.'

They said, 'Well you have the virus that causes what your mother died from.'

It wasn't a total shock to me. I had thought, 'How the hell could I not have it?' So, I guess they verified it for me. So then I had another doctor's appointment. They said Nina your viral load is 380,000 and your T-cells are 14, and you definitely need to be on some sort of medication.' So, the first one I did was the Crixivan method. And then another one. That first combination put me through hell. I had night sweats. I was losing the muscle in my legs (I had always had really athletic legs) and I had no energy whatsoever. I wasn't talking; I wouldn't eat. It was like I was doing drugs again. I was pale and I looked horrible. That happened within three weeks, and then the side effects went away. But [through every other medication change that's happened], I've never had a side effect. I've been on five different regemens in two years. I've built up a big resistance to each. I messed up on the Crixivan and AZT and I decided that I didn't want to take it, because it was only twice a day that I was reminded that I had AIDS, and that was when I had to take my medicine. I really would have rather just shut that out.

If it was up to me I would probably still not be taking [meds]. But I moved in with my step-mom and step-brother, and step-sister, and now I have a very supportive family and they make me take all my medications. When my mom was on her death bed, all she ever said to me was 'Nina, if they ever want you to take medicine, you do it.'

I do all my own research. I read up on every medicine they tell me to take. I have my own book room at work and I ordered all the books I need and share them with everyone else who need the information.

I got an opportunistic infection in my lymph nodes, because I didn't take my medicine [regularly], so now I have to take like 14 extra pills a day. I am taking 25 pills a day. If I didn't have my family to keep me on medication, I wouldn't be alive right now.

The one time I was in the hospital for three weeks, I was right next to a girl who had AIDS. She was 16 and her name was Desiree. I was complaining about my IV and she had breathing tubes. I was complaining because I couldn't go outside and she had never been outside. She lived in the hospital. Her family never came to see her and I was telling my family to get out of my room. She had nothing to live for and I have all these people and all this to live for. And three months ago, I found out that she had died three days after I left the hospital. Whenever I feel like I'm gonna give up I think about her.

Nina

"

You probably heard a lot about HIV and AIDS before you tested positive. As a young person, it may be hard to remember a time before they were household words. A lot of what you heard may have been factual, but chances are, you also heard a lot of rumors and speculations, or guessing. Not everything is as clear as true or false, but there are quite a few facts for you to know and understand if you are going to make healthy decisions.

We don't have space in this guide to explain everything about HIV disease how it develops, its complications, its treatments, and how to take care of yourself as this information could fill many large books. This chapter will only present some basics. Since knowledge about HIV disease and how to treat it changes very fast, this information should be used only as a general guide, as more up-to-date information may be available by the time you read this. (check out the resource section in the back of this guide for additional information.) The information in this chapter is current as of November 1998.

The Basics

HIV (human immunodeficiency virus) is a type of virus (a kind of germ) called a retrovirus which causes HIV disease when it gets inside the human body. AIDS (acquired immunodeficiency syndrome) is the stage of HIV disease in which the body's immune system becomes severely damaged and infections (known as opportunistic infections or OIs for short) develop which would otherwise be easily controlled.

By now you probably know that HIV can be passed from person to person through unprotected oral, anal, or vaginal sex; by sharing needles or other injection equipment; from a pregnant woman to her fetus; and through breast milk. And HIV has to be present in the body fluids of one of the people involved it is infectious and contagious, meaning it is passed between people and does not spontaneously appear because of a certain behavior.

Once HIV is inside the body, it infects cells of the immune system, which is your body's defense against cancer and foreign invaders like bacteria and other viruses. The course of HIV disease is different for different people. With enough time and without adequate treatment, HIV can cause severe damage to the immune system. AIDS is the term we give to the point when your immune system is very strained and unable to work well when the body cannot protect itself from opportunistic infections and certain types of cancers it would otherwise be able to fight off. Untreated, AIDS is terminal and leads to death.

That is the bad news. The good news is that better treatments for HIV/AIDS have become available in the recent years, and new treatments are constantly being studied. With good medical care, it is possible to live well with HIV for a long time. For how long is not known, as the treatment strategies are still very new. As newer, better treatments become available, people with HIV will be able to have a life span and quality of life much like everyone else's. As we have said in the previous chapter, it is important to get yourself good medical care and keep yourself informed about HIV disease, so that you will know as much as you can about staying well.

The Life Cycle of HIV

OK, this is the technical part. We will try to keep it brief. Promise. This section will illustrate the life cycle of HIV and what the virus does once it gets inside your body's cells.

It is helpful to understand this process because treatments for HIV are developed to work on key aspects of the virus' life cycle. If you know the life cycle, you will have some insight into how HIV disease develops (known as pathogenesis) and will better understand HIV treatment options. This will, hopefully, make things a bit less confusing. Don't worry too much about remembering all of the details if you get the general idea, you're doing great. There is a diagram of the life cycle on the next page for you to refer to. Let's follow along, shall we?

  1. (on diagram) This is HIV. An individual virus is called a virion. HIV, like most viruses, is basically just a chunk of genetic material (located in the central core) surrounded by a membrane. The little spikes sticking out of the virion are called glycoproteins or gp for short. These allow HIV to bind with receptors located on the surface of immune system cells and thereby enter the cells, hijack their cellular machinery and produce more HIV. HIV must infect cells and take them over in order to replicate.
  2. This is an immune system cell called a CD4+ T cell. It is responsible for coordinating many of the important functions of your immune system. It is called CD4+ because CD4 is the name of the receptor which is sticking out from the surface of the cell. Notice that the shape of this receptor corresponds to the shape of the gp protruding from the HIV virion. By fitting its gp into the CD4 receptor, HIV is able to bind with and gain entry to the T cell.

Step 1. HIV binding to a CD4+ T cell. This step is known as fusion. The HIV glycoproteins fuse with the CD4 receptor, the surface of the T cell is penetrated, and the genetic material and enzymes from the HIV virion are inserted into the T cell. (An enzyme is a substance which causes biochemical reactions to occur.)

Step 2. Once inside the T cell, the HIV enzymes go to work. In order for HIV to take over a cell and turn it into a virus production factory, it must insert its genetic material into the center or nucleus of the cell. This cannot happen automatically, however. The genetic material in the nucleus of the T cell is DNA, which has two strands. HIV's genetic material, on the other hand, is RNA, which has only one strand. In order to turn its one strand of genetic material into two strands, HIV uses an enzyme called reverse transcriptase. Many of the antiviral drugs used to treat HIV work by inhibiting (blocking) this enzyme. These drugs are called reverse transcriptase inhibitors (RTIs), and come in two main flavors: nucleoside (NRTIs) and non-nucleoside (NNRTIs). Examples of NRTIs include AZT, ddI, ddC, d4T, and 3TC. NNRTIs include nevirapine, delavirdine, and efavirenz. There is an antiretroviral drug chart later in this chapter to help you sort them all out. All of the RTI drugs help to prevent HIV from copying its genetic code into a format that can hijack the T cell.

Step 3. Once HIV has turned its single-stranded RNA into double-stranded DNA, it is ready to integrate its new DNA into the cell's nucleus. Drugs aimed at blocking this stage of the life cycle are called integrase inhibitors, and are still in development.

Step 4. After HIV has inserted its new DNA into the cell's nucleus, it now has control of the cell's machinery, and can start directing the cell to crank out long strands of proteins needed to build new HIV virions.

Step 5. The newly-made HIV proteins are ready to leave the host T cell. This stage is called budding, because new virions are ready to bud off from the host cell.

Step 6. When the virions have budded off from the host cell, they are still immature and cannot infect other cells. Another enzyme, called protease, is required for the virions to become infectious. The protease enzyme works like a pair of scissors that cuts the long protein strands into smaller pieces necessary for the virion to become mature and able to infect other cells. Protease inhibitors (ritonavir, saquinavir, indinavir, nelfinavir) are the drugs which work against this enzyme.


So what does all of this mean?

Well, by infecting T cells, HIV often kills them in the process. This process happens billions of times a day in the body of someone with HIV. At the same time, the immune system is effectively killing billions of HIV virions or T cells infected with HIV. On top of all of this, the body is constantly producing countless new T cells, many of which will go on to be infected with HIV. The immune system is extremely complex, and is delicately balanced. Over many years, the constant battle between HIV and the immune system results in HIV ultimately gaining the upper hand, in addition to potential disruption of the immune system. When this occurs, the immune system is no longer able to control cancers and infections it otherwise could.

Chart of HIV Antiviral Drugs

The Lowdown on Medications

OK, that's it for the technical stuff. If it seemed a bit confusing, wait a while and try reading through it again it may take a couple of times before it seems clear. You can also refer to the chart of HIV antiretrovirals on pages 24 & 25, which will help to make sense of the different treatments available.


What are the drugs used against HIV?

Remember when we talked about how different kinds of HIV antiviral drugs work against different enzymes the virus needs to replicate? The chart gives all of the basic information on each drug their names, the company that makes them, what they look like, how they must be taken, etc. Notice that each drug has more than one name-that is because one is the generic name for the drug, and the other is the brand name (...kind of like cola is a generic name and Pepsi and Coke are brand names). Some of the drugs have abbreviations or code names as well, such as AZT, 3TC, and ddI.


How do you know whether to start taking antivirals?

This is a difficult question to answer. The decision of when to start taking antivirals is a very personal one, something each person with HIV must decide for her/himself. That said, it is also not a decision to be made alone. It is crucial to seek the advice of a good doctor who can assist you in making a wise decision.

Generally, the scientists agree right now that the decision to start antiretrovirals should be based on three main considerations:

  • 1-Clinical status,
  • 2-CD4 count & viral load, and
  • 3-Willingness/ability to stick to a treatment regimen.

Let's break these down:


Clinical status

Clinical status refers to how well you are generally doing, including how well you feel. Your doctor will look at whether you are experiencing symptoms (symptomatic) or not (asymptomatic); or have experienced an opportunistic infection in the past or present. It is strongly recommended that people who are symptomatic or have had an opportunistic infection start treatment, regardless of their CD4 count or viral load.


CD4 count and viral load

You may remember from our discussion about the HIV life cycle that CD4 cells are the T cells which play a major role in coordinating your immune system. The CD4 count is like a snapshot of how well your immune system is doing. Viral load, on the other hand, refers to the amount of HIV present in your blood, and is like a snapshot of what the virus is doing. While these tests do not necessarily translate into how sick or well you are right now, they are important in that they are pretty reliable predictors of how well you will do in the future. People whose CD4 count is low or dropping, and people whose viral load is high or increasing, are more likely to get sick sooner than those with high CD4s and low viral load.

People whose CD4 count is low (below 350) or dropping steadily are generally advised to begin treatment. Likewise, treatment is generally recommended for those whose viral load is above 55,000, or increasing steadily. It is important to understand that some (more aggressive) experts would treat even with higher CD4 counts or lower viral loads than those listed, while still others (more conservative) might put off treatment until the viral load was a bit higher.


Willingness/ability to adhere to regimen, or routine

(Regimen means, the total amount of pills you are taking and the times you have to take them.) This is important because, at least for the foreseeable future, once you start an antiviral treatment for HIV, you should continue it indefinitely. Otherwise, if you forget to take a dose here and there, it is quite possible that HIV will become resistant to the drugs and will no longer work. It is very important to start a treatment only when you are ready to make a realistic commitment to sticking to a regimen, which can mean taking pills several times a day, every day! Feel unsure about your ability to do this? That doesn't mean you should dump the idea of starting treatment, but it does mean that you may need help finding ways to stick to it. Your doctor, case manager, social worker, friends and family should be there for you. Staying on a treatment regimen can be a really difficult task for a young person, who is not used to doing anything every day. Unlike taking a vitamin, eating vegetables or even flossing your teeth, your meds at the suggested times cannot be shrugged off as unimportant.


How do you know which drugs to take?

This is another one of those talk to your doctor questions, because a drug regimen must be tailored to the individual. We can, however, discuss this issue in general terms. Once it has been decided to start taking antivirals, a regimen should be selected which is going to reliably lower the HIV viral load as much as possible for as long as possible. In order to do this, several potent HIV drugs must be combined. This is called combination therapy or HAART (Highly Active Antiretroviral Therapy).

Typically, drugs are combined from different classes, and common examples would include combinations like 2 NRTIs and a protease inhibitor, or 2 NRTIs and an NNRTI. It is important to remember that there are many different things to consider when choosing a drug regimen, and that information in this area changes very fast! Also, the best regimen for someone starting medication may not be the best regimen for someone who has been taking medication for a long time and needs to switch therapies. Therefore, it is best to consult with your doctor about which combination therapies might be right for you.


What about side effects and interactions with other drugs?

Any medicine you put into your body has the potential to affect you in ways you did not plan. These are called side effects and can range anywhere from a minor annoyance to a life-threatening reaction. Potential side effects are different with different medications and with different people. A medication which makes one person feel rotten may have no negative effects on another person. It is important to report any side effects you are having to your doctor, as he/she can help you to manage them or avoid them altogether.

Like side effects, drug interactions are always possible when medicines are taken. Drug interactions occur when one medicine you are taking interacts with another (could be prescription, over-the-counter, herbal, recreational, etc.) to produce a negative or unexpected effect. Again this depends on individual drugs and how each person's body metabolizes them (breaks them down). It is important to tell your doctor everything that you are taking so that dangerous drug interactions can be avoided.


Complications of HIV Disease

HIV can cause many complications. Potential complications include the life threatening opportunistic infections (OIs) and cancers which occur when the immune system has become seriously compromised. Other complications include problems such as dementia, wasting syndrome (severe unintentional weight loss), fatigue, and itchy skin, etc.

It is not necessary for you to know all of the possible complications from HIV disease, and you don't need to panic every time you have a headache or get a runny nose. The earlier you see a doctor about any complications, the better the outcome is likely to be. A doctor familiar with HIV treatment will know if you need to take medicines to prevent OIs or other complications. Combination antiretroviral therapy in itself is helpful in preventing many complications, in that it helps to prevent your immune system from becoming damaged.

However, if a symptom is concerning you or is not going away, it is always best to spend some time with a doctor and get it checked out even if it doesn't feel like a big deal. We've included a list of symptoms that warrant a call to the doctor.

"  I'm scared to take medication, but everyone seems to be pushing me to take them. What should I do?

Stop. Take a deep breath and check in with yourself. Who is "everyone?" Are these people your friends, medical providers, or people you just met? What type of relationship do you have with them? Do you trust them? Do they know you? Are you also feeling pressured by the hype around you, from posters of people with HIV climbing mountains to news reports claiming that all you have to do is take pills? Well, you're not alone. Many people are feeling the pressure to do what they think everyone else is doing.

You and your medical provider may decide it's the right thing to start taking medication especially if there is a progression in your disease -- if, for example, you start feeling sick or your blood tests whow that something is going on inside of you that indicates HIV is doing its thing. The name of the game these days is to prevent you from getting sick in the first place. There may be times when taking medications is the best thing you can do, even if you feel fine.

Some people choose not to take any medicaton. Talk to others who have been taking medications and ask them about their experiences. Have faith in the decisions you make. If you are not ready, then don't take any medications. Remember, medications only work if they are taken correctly. Other medications don't work at all for some people, but you won't know if one works for you unless you try it. Ultimately, the choice is up to you. Try not to let anyone bully you into doing something you are not ready to do.

"

When to call a Doctor

The following symptoms may or may not be serious, but should make you think seriously about calling a doctor right away... don't wait until your next scheduled appointment.

  • Breathing problems:
    Persistent cough
    Wheezing or noisy breathing
    Sharp pain when breathing
  • Skin problems:
    Appearance of brownish, purple or pink blotches on the skin
    Onset of rash -- especially important if you are taking medication
  • Eye/Vision problems:
    Blurring, wavy lines, sudden blind spots
    Eye pain
    Sensitivity to light
  • Aches and Pains:
    Numbness, tingling or pain in hands and feet
    Stiffness in neck
    Severe or persistent cough
    Persistent cramps
    Pain in lower abdomen or during sex (women in particular)
  • Other Symptoms:
    Mental changes -- confusion, disorientation, loss of memory or balance
    Appearance of swollen lymph nodes, especially when asymmetrical (larger on one side of the body)
    Diarrhea -- when severe, accompanied by fever, or lasting more than three days
    Weight loss
    High or persistent fever
    Fatigue
    Frequent urination

Making the Most of Your Medical Care

If you have HIV, the most important thing you can do to take care of yourself is to get good medical care. But how do you get good medical care for HIV especially if you are young and don't have insurance or a lot of money? There are some things you can do to make sure that you get the best medical care possible.

  1. Get connected with a treatment advocate, case manager, peer advocate, or social worker at an agency in your area who is knowledgeable about HIV and works with young people. Such a person can help to connect you with a doctor or clinic in your area that will see you based on your particular situation (no insurance, HMO, undocumented status, etc.). In addition, they can help you to get the benefits you may qualify for and that will help to make medicines or medical care affordable for you.
  2. Don't just see any doctor. Try to find a doctor who sees many patients with HIV generally, the more, the better. (A doctor who sees many HIV patients will usually be very knowledgeable about HIV disease and how to treat it.)

    Spend time looking for a doctor you are comfortable with. Always remember that it is your right to ask questions after all, it's your body. Although it is always best to try to communicate with your doctor if you're not satisfied with your care, if you feel like you're being ignored or are getting unsatisfactory answers it is OK to look for a new doctor.
  3. Make the most of your time with your doctor. Unfortunately, many clinics are very busy and cannot spend unlimited time with each patient every time. To make sure you get your needs met, prepare for your appointment by writing down any questions you have, any symptoms or problems you want to tell the doctor about, and a list of the medications you are taking. That way you won't forget anything during the appointment. If you feel the doctor has forgotten something during the appointment, it is better to ask about it (politely) than to leave wondering whether something was supposed to happen that didn't. Doctors are only human and they forget things just like the rest of us.
  4. Ask for copies of your lab work. Go over the lab work with a doctor, nurse, treatment advocate, or other knowledgeable person so that you understand what it all means. There is a chart that outlines what the most important blood tests for HIV disease mean. Keep copies of your lab work, as this will make it easy for you to refer to them.
  5. Educate yourself. The more knowledgeable you are about HIV and how to treat it, the better you will be at working as a partner with your doctor in your health care decisions. As you learn more, chances are you will be less confused about HIV disease and will become better able to make good decisions. Use the resource section in the back of this guide to get started. Knowledge = Power!

What is a clinical trial?

An HIV/AIDS clinical trial is a research study that involves people and is designed to answer questions about or basically test out the safety and effectiveness of certain HIV/AIDS treatments. As you may guess, all treatments must be tested out before they can be given to a large number of individuals.


Should I take part in a clinical trial?

You may be approached or asked to participate in a clinical trial, and there are a number of reasons to think about participating. For one, you will be able to try the newest medications; for another, you will usually receive very complete medical care while on the trial. Such trials offer a great deal of hope for some people, but they should not be taken on without careful thought about the pros and cons of such an experience.

Educate yourself about everything that will be involved in the trial. For instance, where does it take place? How many other people will be participating in the trial? And what additional lifestyle changes will you have to make while participating? Will you be able to take other medication while you are in the trial? Will you have so many appointments that it will infringe on the rest of your schedule? Will you have to change your diet? On the other hand, you may gain useful, breakthrough information that you could go on to share with your current health care provider(s).

There are three types of studies in the drug development process:

A Phase I Trial, in which a study medication is given to a small group of people for the first time to make sure it is safe.

A Phase II Trial, in which a medication is given to a larger group to see if it works and to further test its safety.

A Phase III Trial, in which the medication is given to large groups of people to see if it works and to develop additional information that will allow the drug to be marketed and used safely.

How do I know it's safe?

This is a hard one. One of the things that could make it potentially unsafe is the fact that you will possibly have to stop taking whatever medication you are currently on. As with many medication regimens, this one could also involve some very yucky side-effects, especially if you are taking part in a trial in its initial stage. There is only so much that a trial can guarantee. It is a trial, after all and there is potential for danger. The federal government has imposed a number of rules to ensure that participants are aware of their risks, and if you do participate, you will be asked to sign an agreement, clarifying the level of risk of each specific trial. (Be sure to ask questions about anything you don't immediately understand. It should be in clear language.) In addition, your body may react not only to the fact that you will begin taking new medication, but it could also react even more dramatically when you have to stop, even if it worked for you. Deciding whether to take part in clinical trials is not something to be taken lightly.

Alternative Therapies

In addition to getting good medical care and checking out research opportunities, many people with HIV use alternative therapies as well. The term alternative therapy (sometimes called complementary therapy) can encompass a wide range of treatments or techniques. Many of these treatments stem from cultures that practice healing outside of Western hospitals, and many of them involve natural, non-synthetic medicines and herbs.

Western medicine, or what we know as the white-coat-wearing medical industry, tends to focus on the symptoms of HIV and other diseases and illnesses. In other words, there is less focus put on preventing illness and staying generally healthy than on illness itself.

On the other hand, most alternative therapies involve viewing your health from a holistic, or whole-picture point of view. This means that they see every aspect of your health, from your stress levels, to the amount of water you drink, to the vegetables you eat, as part of what keeps you healthy. This involves seeing yourself as a system that can grow and change as a whole, rather than as a series of separate bodily interactions. Looking at your health this way can be very helpful in making a shift towards feeling and really being healthier. There are also many types of healing that are based on older cultures and traditions, which stress the importance of a healthy system, while seeing symptoms as only part of the problem. With this outlook, it is as important to make daily choices that will prevent illness, while making it easier to heal small illnesses when they come up. It is possible that certain parts of your body may need work to be healthier even though there may be no direct illness, or you may not feel like there is a problem. For this reason, it may take longer for the symptoms you do feel and see to go away. Alternative remedies not always give you fast results. If you were to look at your body as a house, for instance, it may take a while to reinforce the foundation, before you could fix the walls or ceiling. This is not to say that alternative therapies do not bring about results, but that they often take patience and a great deal of commitment and follow-through.

A number of people living with HIV seek care that is non-Western. Some examples of this are:


Traditional Chinese Medicine:

While many doctors of Chinese medicine practice acupuncture, they also focus on herbs, diet and stress-reduction techniques. In general, it is important to note that Chinese medicine focuses largely on prevention, and treatment will work best if accessed early in the game. Most Chinese herbs are designed to be taken regularly, and many can be taken in conjunction with Western pharmaceuticals. In either case, check with your doctor before you begin any medical regimen.


Acupuncture:

While acupuncture may seem like a frightening concept, it is a very simple process. Yes, it does involve needles but they are very small (the width of a hair), and yes they are in your body (with 360 specific possibilities), but in most cases people find it a very relaxing process. One may feel a warm, tingly sensation, while you rest for 30-45 minutes, allowing the needles to stimulate certain parts of your body's system. Acupuncture has been known to help alleviate the side affects of Western medication.


Massage:

Not only does massage feel good, but it can be very good for reducing stress and helping your body stay healthy. Although it is often too expensive for many young people (running an average of $40-80 an hour) there are several places to get free or sliding-scale massage if you are HIV positive. It may be a splurge, but it is usually worth it.


Reiki:

Reiki is similar to massage in that it involves touch, but on a different level. Reiki focuses of relaxation, and is a gentle form of body work.


Meditation:

While a number of people who meditate do so as part of a larger set of practices or beliefs such Buddhism, meditation can take on many forms. There are a number of places to learn more about meditation, or sitting, as part of keeping a clear, healthy mind.

Most people who have had success with alternative healing will testify to the power of positive thinking. Believing in the power of your body to heal itself is absolutely important as you begin to treat yourself, however you choose to do that.

It is not always easy to avoid treatments which may be fraudulent or dangerous. Some alternative treatments will claim to cure you of HIV or to have miraculous effects. While we all want to be optimistic, there is nothing more cruel that an overblown report about a new treatment.

  • Be wary of treatments that claim to have a magic answer and do your reasearch on any and all treatment plans before you even consider them.
  • If your doctor does not want to talk about alternative treatments, or if he/she is not knowledgeable about them, you may want to consider a doctor who is.
  • There are also a number of naturopaths (professionals who specialize in alternative medicine) and doctors or nurse practitioners who are familiar with both Western and Eastern medicines, to provide you with the most options possible.
  • If you consult more than one kind of doctor, each one should be aware of everything you are doing to treat yourself. Some alternative therapies may have harmful reactions when mixed with a medication already in your body.
  • If you are going to a clinic, be sure to investigate and to talk to other people who have been treated there. There are a number of very expensive private clinics in the country and abroad. In many cases they can be more dangerous than helpful. Be sure to look for information about the clinic published elsewhere, in order to get a more thorough view of exactly what they can do for you.
  • If you are considering an unproven treatment, feel free to interview whoever is promoting it. Find out how familiar they are with HIV and AIDS. Find out about whether they hold entirely different beliefs about the commonly held ideas about HIV, and whether or not their treatment options will conflict with however you may be treating yourself otherwise.
  • Listen to your instincts and ask the advice of friends or supporters who know a lot about HIV/AIDS, and seek out a large variety of opinions.

It is important to note that while certain alternative therapies may be very beneficial, they are not always substitutes for medical care or standard treatments. Let others work with you to make those decisions.

There are referrals to sources of information about alternative medicine in the resource section of this guide.

HIV Lab Tests: What They Mean

There are many lab tests used as diagnostic tools in HIV disease. Some of them are only used for HIV, others are used in other situations as well. Following is a short list of some of the most common lab tests used for monitoring HIV disease, along with a brief description of each.
CD4 count (or "Total CD4+T cells) CD4 cells regulate many important functions of your immune system. These cells decline as HIV progresses. The CD4 count is like a snapshot of how well your immune system is functioning. A typical normal range for CD4 cells would be between 600 and 1500 cells per cubic millimeter.
Viral load (or "HIV RNA") Viral load tests measure the amount of HIV genetic material in the blood. Higher viral load is associated with faster disease progression. The main goal of antiviral medication is to reduce viral load as much as possible as long as possible. There are two common types of viral load test, PCR and bDNA. Some viral load tests measure down to 400 or 500 copies of HIV per until of blood, other go as low as 200 or 50 copies.
Complete blood count (CBC) This set of tests analyzes the different cells in your blood. The CBC can determine how many red blood cells, platelets, and white blood cells are present, and look at the different types of white blood cells present and how well the red cells are functioning.
Liver function tests (LFTs) or liver panel (includes ALT, AST, LDH, & others) Your liver us an organ that processes everything you put into your body, including drugs. Liver function tests can help gauge how well your liver is doing. Drug toxicity and viral hepatitis can cause high liver function tests, which indicate that the liver may be at risk of being damaged.
TB test (or "TB PPD") TB is short for tuberculosis, a lung disease that people with HIV are at high risk for. A PPD test is a special skin test to see if you have been exposed to TB. In some people with HIV, the PPD test is not reliable and a chest x-ray or sputum culture is done instead.
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