HIV 101: Will Being HIV-Positive Affect My Ability to Have Surgery?

Talking About Your HIV Status

HIV 101: Will Being HIV-Positive Affect My Ability to Have Surgery?

It's important to share your status with your sex partner(s) and/or people with whom you inject drugs. Whether you disclose your status to others is your decision.

Partners

It's important to disclose your HIV status to your sex partner(s) and anyone you shared needles with, even if you are not comfortable doing it. Communicating with each other about your HIV status means you can take steps to keep both of you healthy.

The more practice you have disclosing your HIV status, the easier it will become. Many resources can help you learn ways to disclose your status to your partners. For tips on how to start the conversation with your partner(s), check out CDC's Start Talking. Stop HIV. campaign.

If you're nervous about disclosing your test result, or you have been threatened or injured by a partner, you can ask your doctor or the local health department to help you tell your partner(s) that they might have been exposed to HIV. This type of assistance is called partner notification or partner services. Health departments do not reveal your name to your partner(s). They will only tell your partner(s) that they have been exposed to HIV and should get tested.

Many states have laws that require you to tell your sexual partners if you're HIV-positive before you have sex (anal, vaginal, or oral) or tell your drug-using partners before you share drugs or needles to inject drugs. In some states, you can be charged with a crime if you don't tell your partner your HIV status, even if you used a condom or another type of protection and the partner does not become infected.

Health Care Providers

Your health care providers (doctors, clinical workers, dentists, etc.) have to know about your HIV status in order to be able to give you the best possible care. It's also important that healthcare providers know your HIV status so that they don't prescribe medication for you that may be harmful when taken with your HIV medications.

Some states require you to disclose your HIV-positive status before you receive any health care services from a physician or dentist. For this reason, it's important to discuss the laws in your state about disclosure in medical settings with the healthcare provider who gave you your HIV test results.

Your HIV test result will become part of your medical records so that your doctor or other healthcare providers can give you the best care possible.

All medical information, including HIV test results, falls under strict confidentiality laws such as the Health Insurance Portability and Accountability Act's (HIPAA) Privacy Rule and cannot be released without your permission.

There are some limited exceptions to confidentiality. These come into play only when not disclosing the information could result in harm to the other person.

Family and Friends

In most cases, your family and friends will not know your test results or HIV status unless you tell them yourself. While telling your family that you have HIV may seem hard, you should know that disclosure actually has many benefits—studies have shown that people who disclose their HIV status respond better to treatment than those who don't.

If you are under 18, however, some states allow your health care provider to tell your parent(s) that you received services for HIV if they think doing so is in your best interest. For more information, see the Guttmacher Institute's State Policies in Brief: Minors' Access to STI Services.

Employers

In most cases, your employer will not know your HIV status unless you tell them. But your employer does have a right to ask if you have any health conditions that would affect your ability to do your job or pose a serious risk to others. (An example might be a health care professional, a surgeon, who does procedures where there is a risk of blood or other body fluids being exchanged.)

If you have health insurance through your employer, the insurance company cannot legally tell your employer that you have HIV. But it is possible that your employer could find out if the insurance company provides detailed information to your employer about the benefits it pays or the costs of insurance.

All people with HIV are covered under the Americans with Disabilities Act. This means that your employer cannot discriminate against you because of your HIV status as long as you can do your job. To learn more, see the Department of Justice's ADA.gov/HIV website.

It may help you to hear stories about how others are living with HIV and how they've shared their status with partners, family, and friends. Visit Positive Spin or CDC's websites for Let's Stop HIV Together and HIV Treatment Works.

For more information about sharing your HIV status, visit CDC's HIV Treatment Works campaign's content on sharing your status.

Learn more about how to protect yourself and your partners, and get information tailored to meet your needs from CDC's HIV Risk Reduction Tool (BETA).

Источник: https://www.hiv.gov/hiv-basics/hiv-testing/just-diagnosed-whats-next/talking-about-your-hiv-status

Neurological Complications of HIV

HIV 101: Will Being HIV-Positive Affect My Ability to Have Surgery?

HIV is the virus that causes AIDS. HIV weakens and slowly destroys the body’s immune system, leaving you vulnerable to life-threatening complications from an infection or certain cancers.

As HIV and AIDS battle your immune system, your central nervous system is also affected. HIV and AIDS both cause a number of neurological complications, particularly if HIV progresses to AIDS.

Today, antiretroviral medicines—when taken correctly and promptly—help to slow down the progression of HIV. They also help to delay the onset of or to decrease the risk of progression to AIDS. Controlling HIV can also reduce your risk for neurological complications of HIV.

Facts about HIV/AIDS

HIV is a virus that's sexually transmitted, but can also be passed from mother to baby and person to person by sharing a contaminated needle or through transfusion of contaminated blood.

Untreated, the virus will continue to replicate in the body, becoming more and more advanced. Advanced HIV becomes AIDS.

This often results in a number of neurological complications as the body becomes more damaged.

HIV doesn't seem to take over the cells in your nervous system, but it does cause significant inflammation in the body. This inflammation can damage the spinal cord and brain and prevent your nerve cells from working the way that they should.

Neurological complications may result not only from damage caused by the virus itself, but also from other side effects of HIV and AIDS, such as cancers that are associated with these diseases.

Some of the drugs used to treat HIV and AIDS can also cause neurological complications while attempting to control the rapid spread of the virus.

Certain genetic factors can influence the risk of neurological side effects from HIV medicines.

Neurological complications don't usually set in until HIV is advanced, typically when someone has AIDS. About half of adults with AIDS suffer from neurological complications related to HIV.

Types of neurological complications of HIV

HIV can cause many different conditions that affect the nervous system:

  • Dementia. When HIV becomes very advanced, HIV-associated dementia or AIDS dementia complex can occur. These disorders impair cognitive function. This means that you may have trouble thinking, understanding, and remembering. This type of dementia can be life-threatening. It can often be prevented when antiretroviral medicines are taken correctly.
  • Viral infections. HIV can increase your risk for several viral infections that strike the nervous system. Cytomegalovirus infections can negatively affect cognitive function, physical control ( the use of legs and arms and bladder control), vision and hearing, and your respiratory system, causing problems pneumonia. People with AIDS are also ly to develop a herpes virus infection, shingles, inflammation in the brain, and inflammation, in the spinal cord. Another condition, progressive multifocal leukoencephalopathy (PML) is also caused by a virus. PML is aggressive and dangerous. In some circumstances, it can be controlled with antiretroviral medicines.
  • Fungal and parasitic infections. Cryptococcal meningitis is caused by a fungus and leads to serious inflammation of the spinal cord and brain. A parasite can cause an infection called toxoplasma encephalitis, which often leads to confusion, seizures, and extremely painful headaches. Both of these infections can be life-threatening.
  • Neuropathy. HIV can cause damage to nerves throughout the body, resulting in significant pain or weakness, known as neuropathy. Neuropathy is most common in people with advanced HIV.
  • Vacuolar myelopathy. This condition occurs when tiny holes develop in the fibers of the nerves of the spinal cord. It causes difficulty walking, particularly as the condition gets worse. It's common in people with AIDS who aren't receiving treatment and also in children with HIV.
  • Psychological conditions. People with HIV or AIDS often develop anxiety disorders and suffer from depression. They may also experience hallucinations and significant changes in behavior.
  • Lymphomas. Tumors called lymphomas often strike the brain of people with HIV. They're often related to another virus, similar to the herpes virus. Lymphomas can be life-threatening, but good management of HIV can make treating lymphomas more successful.
  • Neurosyphilis. If an HIV-infected person also has syphilis that goes untreated, it can quickly progress and damage the nervous system. It can cause the nerve cells to break down and lead to loss of vision and hearing, dementia, and difficulty walking.

Symptoms

Once HIV begins affecting your immune system, it can cause many different symptoms. HIV-related neurological complications may lead to:

  • Suddenly forgetting things all the time or acting confused
  • Feeling of weakness that keeps getting worse
  • Changes in behavior
  • Headaches
  • Problems with balance and coordination
  • Seizures
  • Changes in your vision
  • Difficulty swallowing
  • Losing feeling in your legs or arms
  • Mental health problems anxiety and depression

Diagnosis

Although a blood test can diagnose HIV and AIDS, a number of other diagnostic tests are needed to look at the different parts of the nervous system and diagnose neurological problems. Tests often include:

  • An electromyography to measure the electrical activity of the muscles and nerves
  • Biopsy to analyze a sample of tissues and to help identify tumors in the brain or inflammation in the muscles
  • Magnetic resonance imaging, which uses radio waves and powerful magnets to image the brain structures. This is the most powerful conventional imaging tool and can detect brain inflammation, many infections, tumors, strokes, and tissue destruction within the brain and spinal cord.
  • Sample of cerebrospinal fluid to look for infections, bleeding, or other abnormalities affecting the spinal cord or brain
  • CT scan, which uses X-rays to reconstruct a 3-D image of the brain. This test is faster and less expensive, but provides less detail than an MRI scan.

Treatment

Antiretroviral medicines are used to stop HIV from replicating and spreading throughout the body. They are also used to help reduce the risk that it will cause damage to the nervous system.

Specific neurological conditions and complications are treated differently. Cancer may be treated with chemotherapy and radiation, and bacterial infections need antibiotics.

Certain medicines may help manage viral infections, and medicines to manage pain can help to ease nerve pain.

Counseling and medicines, including antidepressants, may be used to manage some of the psychological conditions associated with HIV.

Prevention

Following all of your healthcare provider's recommendations, especially taking all antiretroviral medicines exactly as prescribed, can help control HIV and prevent its progression. Suppressing the virus with medicines can help prevent damage to the body, including nervous system damage and neurological complications.

Managing HIV

Living a healthy lifestyle can help you better control HIV and prevent the progression to AIDS. Eating a healthy diet and maintaining a healthy body weight, exercising regularly, practicing safe sex, and following your medicine regimen are all important steps in managing HIV.

Источник: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids/neurological-complications-of-hiv

A Surgeon with HIV

HIV 101: Will Being HIV-Positive Affect My Ability to Have Surgery?

Dr. Kelly paced nervously outside her colleague’s door. All during surgery, her mind had been traveling back to the employee health clinic she had visited earlier in the week. Three months prior, she had suffered a needlestick injury while operating on a young boy who was receiving a liver transplant.

At first she shrugged it off. She knew the boy was HIV-positive, but she didn’t think seroconversion could happen to her. Occupational health gave her post-exposure prophylaxis, and she thought she would be ok.

She felt as if the walls were closing in when she was informed that she had in fact become HIV-positive.

Dr. Kelly knocked on Dr. Chin’s door. She and Dr. Chin had pushed each other through med school and surgery residency, and were now faculty at an academic medical center—Dr. Kelly in pediatric transplant surgery. She trusted Dr. Chin and respected her medical opinion. Dr. Kelly entered and, after exchanging the requisite pleasantries and hospital gossip, she dove straight in.

“Do you remember that needlestick injury I had a few months ago? Well I got my HIV test results back, and I’m positive.”

“What are you going to do now?” Dr. Chin asked crisply, bedside manner not her strong suit.

“Well, I have the name of one of the ID docs here who specializes in HIV. I need to set up an appointment. I guess I will start on antiretrovirals depending on my CD4 counts.”

“No I mean about your career; you won’t be able to operate anymore. Have you told the chief yet? Maybe you could be switched to full-time research faculty.”

Dr. Kelly took a deep breath; this was the very issue she had been struggling with since her diagnosis. She didn’t relish the thought of being the patient, having never taken as much as a single sick day throughout her residency. But, operating was her life. She wasn’t married and had no kids. Being a surgeon had been her dream since she had been a little girl.

“Well, I’ve been reading up on transmission of HIV during surgery,” said Dr. Kelly. “The risk is negligible with proper precautions, which we routinely use.”

“But once you tell your patients’ families, they are going to demand to be treated by a different physician,” said Dr. Chin. “No parents are going to want to expose their kid to an HIV-positive doctor.”

“Well, if the risk of transmitting the virus is so low, do I really need to tell them? It’s not as if we disclose every minor risk when we consent families, so why should I bring it up? My HIV status is none of their business.”

“But aren’t you obliged to inform your patients and their families? After all it could have dire consequences for the kids if they did contract the virus from you?”

Dr. Kelly sighed and thanked Dr. Chin for her time. She retreated to her office to ponder her next course of action.

Commentary

Good ethical decisions begin with good facts. Dr. Kelly just received disturbing news with serious potential implications for her and her patients. She is understandably concerned and seeks support and advice from her trusted colleague. When Dr.

Kelly shares her newly discovered HIV status, Dr. Chin responds quickly, bluntly, and unequivocally that this will mean the end of surgical practice. It seems as if she made a diagnosis and recommended a treatment without verifying or gathering any information.

Fortunately, Dr. Kelly does not seem to be ill or in immediate jeopardy, so this doesn’t appear to be an emergency that requires an immediate response.

Perhaps it’s worth taking some time to review the presumptions that led to what may have been a premature or even incorrect conclusion.

Dr. Kelly has a positive test result for HIV infection and she has at least one risk factor we know about, a needlestick injury from an infected patient. Such exposures, however, rarely lead to infection, with the rate being in the range of 3 per 1,000 events [1].

Also, she has no reported symptoms that would suggest active infection. In light of these facts, a second test to confirm the result would be prudent.

While a false positive result would be unusual, it is possible, and could arise from a mislabeled blood specimen or misreported result.

What does Dr. Kelly now need to know and why? For herself, she needs to know whether she has HIV and, if so, the age of her infection.

Are there organs or systems affected? What is the status of her immune system? How can she expect this infection to affect her? What are the indications for and the benefits and risks of treatment? In this way, she is no different than others with newly diagnosed HIV infection. But she is different in a significant way.

She is a physician, and her profession and role impose a set of duties and obligations. These raise additional questions and concerns. She has accepted the obligation to do no avoidable harm, be as skilled and knowledgeable as she can be, recommend and do what is best for her patients, and be honest with them.

Besides these “duties of station” she also has assumed the responsibility and challenge of providing the facts that her patients need in order to give voluntary informed consent for her to perform surgery on them.

With respect to her probable and newly recognized HIV infection, this means Dr. Kelly needs to know if it will impair her ability to perform her tasks safely and competently and whether it will pose any significant risk to her patients now or in the future. If she is or becomes impaired, she should remedy or resolve the impairment.

This could mean corrective lenses for decreased vision or drug treatment for infections that compromise other functions. If that’s not possible, she may need to limit or change the kind of surgery she performs. Even if she is unimpaired and asymptomatic, she should be aware of the risk she may pose of transmitting HIV infection to a patient.

This will depend both on the status of her infection, e.g., viral load and the lihood that she will sustain an injury that results in a patient’s exposure to her blood. For significant identified risks, she should eliminate or minimize the risk. This could involve measures antiretroviral therapy that control infection.

It could also mean taking actions to reduce the lihood of transmission such as using gloves or avoiding high-risk procedures that increase the chance of injury.

Now let’s examine Dr. Chin’s reflex conclusion that Dr. Kelly will need to abandon the surgery she loves. There was an alternative presumption that, if she continued, she would have to disclose her HIV infection status.

The latter came with a corollary that when patients’ parents learned her status they would decline to have her operate on their children. To get beyond presumptions and pursue an evidence-based response to her situation, Dr.

Kelly should consult quickly with an infectious-disease specialist with expertise in the evaluation of HIV infections. Preferably he or she should also be associated with the hospital’s infection-control program.

While the authenticity and relevant details of Dr. Kelly’s infection remain to be determined, some general observations can be made. Although transmission of HIV from surgeon to patient is possible, it is, in fact, extremely rare.

The CDC has estimated that the average risk of sporadic HIV transmission from an HIV-infected surgeon to a patient during an invasive procedure was 2.4 to 24 episodes of transmission per 1 million procedures [2, 3].

The physician’s viral load with or without treatment is a reasonable surrogate for potential infectivity, and is measured well by laboratory tests. The lihood of actually transmitting an infection relates to the risk of an injury that causes bleeding from the surgeon’s hand during an operation.

This is best assessed by experienced surgeons and a review of the infection-control literature. As a rough guide, one would anticipate more such injuries in the course of orthopedic procedures with exposure to sharp bone fragments than in general surgery limited to abdominal organs or soft tissues.

Pending laboratory tests, it seems reasonable to conclude that, without treatment or after effective treatment, Dr. Kelly’s viral load will be low. If colleagues and the infection-control committee believe her surgery practice does not entail high risk, then, if she is otherwise unimpaired, she should be able to resume surgery [4, 5].

Whether Dr. Kelly should disclose her HIV status to her patients is the remaining ethical question.

Because of the severity, fear, and uncertainty about transmission and the social stigma associated with the debut of the AIDS/HIV epidemic, we treated this syndrome as exceptional and implemented different approaches to testing, confidentiality, counseling, and infection control.

Abundant evidence has accumulated about infectivity, transmission, and the efficacy of treatment and infection-control methods on these factors. It is time to incorporate that evidence into our ethical reasoning.

The risk of HIV acquisition from an infected surgeon appears much lower than the risk of nosocomial bacterial infections, even those with lethal potential. These rates vary by surgeon and institution. It is not the practice, at least not yet, for surgeons to disclose their personal complication or postoperative infection rate to prospective patients.

Similarly, most surgeons don’t spontaneously disclose the number of similar cases they do annually, another factor associated with complication rates. Given this practice, it seems inappropriate to require disclosure of a lower-risk condition. That may change, of course, as risk-adjusted institutional and even surgeon-specific data become publicly available.

Until then, however, disclosure of HIV status seems inappropriate. It may arouse anxiety unnecessarily and have no practical effect on risk reduction [5].

 It may be that some patients would be more fearful of a low risk of perioperative HIV infection than of a serious adverse drug reaction, postoperative hemorrhage, or sepsis, but that is not a strong argument for routine disclosure. It is a reason, though, to answer a direct question truthfully.

While there may be an understandable reluctance to answer a patient’s pointed question about his or her surgeon’s HIV status, medical ethics and respect for persons demand an honest answer, just as they would to a question about training, experience, or complication rates.

This case invites us to think, in a patient-centered and generic way, about the risks, real and potential, that surgeons pose to patients and how they should be managed. Known serious risks should absolutely be avoided. Examples include surgeons with highly communicable infectious diseases such as influenza, varicella, and hepatitis B.

Abstaining from surgery during such clinical infection is appropriate. Primary prevention via immunization is an even better, more ethically appropriate, and efficient strategy. If the risk is real, but much lower and not reducible by actions available to the surgeon, disclosure may be an appropriate strategy.

Examples here would be surgeon or hospital-specific infection rates.

Reasonable and truly informed consent remains a challenge, both as a process and as an outcome. If Dr. Kelly clearly explains to her patients the medical indications, expected outcomes, reasonably anticipated risks and adverse events, benefits, and alternatives, she will be doing an ethically competent job and probably a better one than most of her colleagues.

References

  1. Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med. 1997;337(21):1485-1490.
  2. Bell DM. Human immunodeficiency virus transmission in health care settings: risk and risk reduction. Am J Med. 1992;91(3B):294S-300S.
  3. Schwaber MJ, Sereti I.

    Investigation of patients treated by an HIV-infected cardiothoracic surgeon—Israel, 2007. MMWR Morb Mortal Wkly Rep. 2009;57(53):1413-1415.

  4. Centers for Disease Control and Prevention. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR Morb Mortal Wkly Rep.

    1991;40(RR-8):1-9.

  5. Reitsma AM, Closen ML, Cunningham M, et al. Infected physicians and invasive procedures: safe practice management. Clin Infect Dis. 2005;40(11):1665-1672.

Virtual Mentor. 2009;11(12):933-937.

10.1001/virtualmentor.2009.11.12.ccas1-0912.

The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

Источник: https://journalofethics.ama-assn.org/article/surgeon-hiv/2009-12

HIV Treatment

HIV 101: Will Being HIV-Positive Affect My Ability to Have Surgery?

What is HIV treatment?

HIV treatment involves taking medicine that reduces the amount of HIV in your body.

  • HIV medicine is called antiretroviral therapy (ART).
  • There is no effective cure for HIV. But with proper medical care, you can control HIV.
  • Most people can get the virus under control within six months.
  • Taking HIV medicine does not prevent transmission of other sexually transmitted diseases.

When should I start treatment?

Start Treatment As Soon As Possible After Diagnosis

  • HIV medicine is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are.
  • Talk to your health care provider about any medical conditions you may have or any other medicines you are taking.
  • Let your health care provider know if you or your partner is pregnant or thinking about getting pregnant. They will determine the right type of HIV medicine that can help prevent transmitting HIV to your baby.

What if I delay treatment?

  • HIV will continue to harm your immune system.
  • This will put you at higher risk for developing AIDS. Learn more about AIDS and opportunistic infections.
  • This will put you at higher risk for transmitting HIV to your sexual and injection partners.

What are the benefits of taking my HIV medicine every day as prescribed?

Treatment Reduces the Amount of HIV in the Blood

  • The amount of HIV in the blood is called viral load.
  • Taking your HIV medicine as prescribed will help keep your viral load low and your CD4 cell count high.
  • HIV medicine can make the viral load very low (called viral suppression).

    Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.

  • HIV medicine can make the viral load so low that a test can’t detect it (called an undetectable viral load).
  • If your viral load goes down after starting HIV treatment, that means treatment is working.

    Continue to take your medicine as prescribed.

  • If you skip your medications, even now and then, you are giving HIV the chance to multiply rapidly. This could weaken your immune system, and you could become sick.

  • Getting and keeping an undetectable viral load (or staying virally suppressed) is the best way to stay healthy and protect others.

Treatment Helps Prevent Transmission to Others

  • If you have an undetectable viral load, you have effectively no risk of transmitting HIV to an HIV-negative partner through sex.
  • Having an undetectable viral load may also help prevent transmission from injection drug use.

    We don’t have data about whether having an undetectable viral load prevents transmission through sharing needles, syringes, or other injection equipment (for example, cookers). It very ly reduces the risk, but we don’t know by how much.

  • Having an undetectable viral load also helps prevent transmission from mother to baby.

    If a mother with HIV takes HIV medicine as prescribed throughout pregnancy, labor, and delivery and gives HIV medicine to her baby for 4 to 6 weeks after birth, the risk of transmitting HIV to her baby can be 1% or less.

  • Having an undetectable viral load reduces the risk of transmitting HIV to the baby through breastfeeding, but doesn’t eliminate the risk. The current recommendation in the United States is that mothers with HIV should not breastfeed their babies.

Taking Treatment as Prescribed Helps Prevent Drug Resistance

  • Taking HIV medication consistently, as prescribed, helps prevent drug resistance.
  • Drug resistance develops when people with HIV are inconsistent with taking their HIV medication as prescribed. The virus can change (mutate) and will no longer respond to certain HIV medication.
  • If you develop drug resistance, it will limit your options for successful HIV treatment.
  • Drug-resistant strains of HIV can be transmitted to others.

Does HIV medicine cause side effects?

HIV medicine can cause side effects in some people. However, not everyone experiences side effects.

The most common side effects are

  • Nausea and vomiting,
  • Diarrhea,
  • Difficulty sleeping,
  • Dry mouth,
  • Headache,
  • Rash,
  • Dizziness,
  • Fatigue, and
  • Pain.

Talk to your health care provider if your treatment makes you sick. Your health care provider may prescribe medicines to help manage the side effects or may change your treatment plan.

Will HIV treatment interfere with my hormone therapy?

  • There are no known drug interactions between HIV medicine and hormone therapy.
  • Talk to your health care provider if you are worried about taking HIV medicine and hormone therapy at the same time. Your health care provider will help you stay healthy and ensure your hormone therapy stays on track.

What if my treatment is not working?

  • Your health care provider may change your prescription.
  • A change is not unusual because the same treatment does not affect everyone in the same way.

Sticking to my treatment plan is hard. How can I deal with the challenges?

Tell your health care provider right away if you’re having trouble sticking to your plan. Together you can identify the reasons you’re skipping medications and make a plan to address those reasons.

Talk to your health care provider about problems taking your HIV medicine.

  • Problems taking pills. This can make staying on treatment challenging. Your health care provider can offer tips and ideas for addressing these problems.
  • Side effects from medicine. Nausea or diarrhea can make a person not want to take their pills. There are medicines or other support, nutritional counseling to make sure you’re getting important nutrients. This can help with the most common side effects.
  • Treatment fatigue. Some people find that sticking to their treatment plan becomes harder over time. Make it a point to talk to your health care provider about staying on your treatment plan.

Plan ahead and keep extra medicine with you.

  • A busy schedule. Work or travel away from home can make it easy to forget to take pills. It may be possible to keep extra medicine at work or in your car. But talk to your health care provider first. Some medications are affected by extreme temperatures and it is not always possible to keep medications at work.

Find help for mental health or substance use disorders.

  • Being sick or depressed. How you feel mentally and physically can affect your willingness to stick to your treatment plan. Your health care provider, social worker, or case manager can refer you to a mental health provider or local support groups.
  • Alcohol or drug use. If substance use is interfering with your ability to keep yourself healthy, it may be time to quit or better manage it.
  • If you need help finding substance use disorder treatment or mental health services, use SAMHSA’s Treatment Locatorexternal icon.

Talk to your health care provider if you miss a lot of doses of your HIV medicine.

  • Missing a dose. In most cases, you can take your medicine as soon as you realize you missed a dose. Then take the next dose at your usual scheduled time (unless your pharmacist or health care provider has told you something different).

  • Missing a lot of doses. Talk to your health care provider or pharmacist about ways to help you remember your medicine. You and your health care provider may even decide to change your treatment routine to fit your health care needs and life situation.

Join a support group or ask your family and friends for support. They can help you stick to your treatment plan.

Источник: https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html

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