Choosing and starting treatment The right treatment for youBefore beginning treatment for HIV, it’s important that you find a drug combination that suits you. In addition to your HIV doctor, there should be health advisers or treatment advisers available at your clinic. They can discuss your treatment options with you and help you decide the most tolerable and effective combination of drugs with the lowest impact on your lifestyle. When choosing the right combination of anti-HIV drugs, there are three main issues to consider and discuss with your HIV doctor: The potential side effects of the drugs Your resistance to any of the drugs The practicalities of taking the different drugs Potential side effects of the drugs All anti-HIV drugs can have short-term side effects, although not everyone experiences these and in most cases they tend to disappear after a month or so. However, different anti-HIV drugs can have different long-term side effects which are worth considering when choosing which combination of drugs to take. Make sure you discuss these with your doctor so that he or she can indicate which drugs will be least likely to produce unwanted long-term side effects. Resistance to the drugsWhether you are starting treatment for the first time, or changing treatment from one combination of anti-HIV drugs to another, you should first have a resistance test performed by your HIV clinic. This will show whether your HIV is resistant to any anti-HIV drugs, and therefore which drugs will be effective against your HIV. Resistance to anti-HIV drugs can occur if you don’t take your drugs at the right time every day. Even if you do there is a chance that resistance to the drugs you are taking can happen over time. It’s also possible to be infected with a strain of HIV that is already resistant to some of the anti-HIV drugs available. Practicalities of taking the drugsSince it’s important that you take your HIV treatment on time every day, it’s important for you find a combination of drugs that are practical for your lifestyle. The number of pills you need to take, the number of times a day you take the pills and the recommended times when you should take your pills are all variables that make some combinations more practical than others. The number of pills you need to take is known as your pill burden. If you find it difficult to take lots of pills then you and your doctor should look for a combination with a low pill burden. Some combinations of anti-HIV drugs only need to be taken once a day, whereas others need to be taken twice a day or more. If you choose a combination that involves taking pills twice a day then you’ll need to take the doses twelve hours apart. You’ll also need to make sure there are two time periods in your day, every day, when you’ll be able to take your pills. Either your work or your social life may make this difficult so it’s important that you give this some careful consideration. Some anti-HIV drugs should to be taken with food, some should to be taken on an empty stomach and some have no food restrictions at all. There are also some anti-HIV drugs that are recommended to be taken just before you go to bed as their side effects can make you feel drowsy or spaced out. These are also factors that you should consider when deciding which combination will fit in best with your lifestyle. "I knew what I wanted from the drugs I would have to take. I didn’t want ones that I had to take with food, I didn’t want the timing of the doses to be too strict, and I wanted drugs that were all taken the same amount of times a day, not some that I’d have to take twice a day and others three times a day for example. I wasn't too worried about the numbers of pills, but I know friends who prefer as few as possible. I told my doctor and we came up with the combination I'm on." (Richard, 38)Starting treatmentIf you are starting HIV treatment for the first time, be prepared for any potential side effects you may experience in the first few weeks after starting your treatment. The most common side effects at first are nausea, diarrhoea, fatigue and sometimes a body rash. Speak to your doctor or a health adviser about the common side effects associated with the drugs you will be taking, as they may be able to prescribe you with anti-nausea or anti-diarrhoea medication. You may want to plan ahead in case you find you need time off work whilst your body is getting used to the anti-HIV drugs. It’s also a good idea to look after yourself when starting treatment. Having a hectic social life, drinking or taking recreational drugs may mean that it’s harder for your body to get used to the drugs. This could result in side effects that are more severe than they would otherwise be. If you do experience any side effects, don’t stop taking your anti-HIV drugs without medical advice from either your HIV doctor or the on-call doctor at the drop in service at your clinic. They will be able to advise you what to do. If you need to change the drugs you are taking, your doctor will be able to tell you how to change your treatment without risking developing resistance to any of the drugs. Coping with any initial side effects and getting used to the routine of taking medication may, at first, seem very strange. Just take it one day at a time. Likewise, the realisation that you will have to take anti-HIV drugs and keep to a routine, possibly for the rest of your life, can create a psychological burden. Most men settle down to the new routine and notice the side effects improving within a few weeks. However, if you are finding it difficult, speak to your doctor or a health adviser at your clinic as they should be able to give you help and advice about getting through this initial period. You could also ask to be referred to a counsellor through your clinic, or alternatively through one of the agencies listed in the section on Help and Support.