Starting ART

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01 Dec 2014

Michelle from Geraldton writes:

I’d like to start treatment but I’m a bit worried about side effects, some of my friends have had random ones. What should I expect? And how should I choose between what’s available? When can I expect results?

Dr Louise replies:

The decision-making aroundantiretroviral treatment is acomplex one that has to take anumber of factors into account.The most important thing to noteis that being on treatment improves outcomes for individuals and reduces transmissions to others.

We are fortunate these days to have a wide choice of HIV treatment options meaning we can usually find a combination that suits each individual. There are three once-daily fixed-dose combination pills available containing multiple medications in one pill.

In choosing the combination for you, the first thing the clinician looks at is what will be most effective based on the genetic profile of the virus. Standard practice now is to order a genotype test of the virus to determine if there are any resistance mutations that would reduce the effectiveness of treatment.

For many people who have never been on treatment this test often reveals that the virus is fully susceptible — i.e., any appropriate combination of the medications will work and result in viral suppression. Then we need to look at other considerations when choosing the regimen. Other medications the person may be on have to be taken into account in order to identify potential drug interactions; so too, other medical conditions (such as kidney or liver problems, co-infection with hepatitis B or C); and also lifestyle factors.

The most important determinant predicting treatment outcome is that the tablet regimen is taken as strictly directed all the time. This is the crux — we are asking you to take a pill or combination of tablets every day for the rest of your life. There are ways we can help with adherence (alarms, apps and prompts etc.).

Nowadays the medications are extremely effective and a decrease in viral load is usually seen within weeks to months. Usually, after a combination is selected, you would have a review a few weeks later to check for early side effects.

So what side effects can be expected? Any medication can have side effects and these may be obvious early on — such as a rash — or may occur without any overt symptoms, e.g., a decline in kidney function. Usually your doctor will discuss the common side effects that may be associated or occur with the combination prescribed. Talk to your doctor or nurse about any side effects that you are experiencing.

However, for most people on HIV treatment the most common side effect is a robust CD4 count and an undetectable viral load. And that’s no bad thing!

Keep your questions under 100 words and email them to

Dr Louise’s advice is not meant to replace or refute that given by your own health practitioner, who is best placed to deal with your individual health needs.