HIV Drug Resistance and the Importance of Taking Your Medications

by Eric Ward

From PHN Issue 33, Summer 2017

If you have HIV, your prison should treat you during the time you are incarcerated. There is no cure for HIV, but taking the HIV meds will allow you to live longer and with fewer symptoms. Taking your HIV meds as prescribed can also reduce the risk of transmitting HIV to other people.

Here are three things you can do to effectively manage your HIV:

1) Learn about how HIV is treated.

2) Be careful to take your pills exactly as they are prescribed, following the instructions about when to take them, with food or without, etc.

3) Learn about HIV drug resistance and how to best prevent it.

Getting out soon? Contact an HIV clinic outside in advance of your release, in order to make sure your HIV care and treatment are not interrupted.

How is HIV treated?

HIV is treated by medications called antiretroviral therapy, or ART for short. ART stops HIV from making copies of itself inside your body, though it can never stop this process entirely. The number of copies you have in your blood is called your viral load. It is helpful to track your viral load because it can give you signs about whether your meds are working or not. If you are on meds and your viral load rises over time, you may have some HIV drug resistance. If your viral load rises just once, that may be a blip—watch for a pattern over time.

What is HIV drug resistance?

Whenever the HIV virus makes copies of itself, the copies can include small mutations. A mutation is a small change to the structure of the virus. This means some copies of the HIV virus in your body are unique. They are not exact copies.

Because mutations happen randomly, most of them do not help the virus survive in your body. But some mutations change how the virus copies itself. These mutations are bad for you, because your medications will no longer work as well on these mutated viruses. HIV drug resistance occurs when there are enough copies of the mutated virus that your medications no longer keep your viral load down.

Are you getting good medical care?

Because the HIV virus in each person can be different, the treatments can be different. Some medicines work very well for many different people. But there is no “one-size-fits-all” treatment for HIV. To manage HIV, you need a healthcare provider who knows the details about HIV in your body, as well as your general health.

Drug resistance testing gives your healthcare provider information about the HIV in your body and which medications may work for you and which ones may not. It is currently recommended that everyone who tests positive for HIV gets drug resistance testing.

You can get a mutated form of the virus when you first acquire HIV. (This is why it is important to get drug resistance testing at the start of your treatment.) But the virus can also mutate inside you, or you can acquire a mutated strain of the virus from someone else living with HIV. For this reason, drug resistance testing may also be a part of your ongoing care.

Are you taking your medications regularly?

Having the right medicines isn’t enough. You need to take the pills you are given, exactly as they are prescribed. This is called medication adherence. If you don’t take your medicines, or don’t take them regularly, you increase the risk that the virus will mutate and become resistant to your medications.

There is a reason that patients on ART take more than one type of medicine for their HIV. Different medications attack the virus in different ways. The medications work together like players on a sports team. If one player is missing, the whole team does not play well. This is why it is important to take all the medications your doctor prescribes. 

If you don’t get your meds on time, you may have to advocate for yourself using your facility’s grievance procedure.

Sometimes more than one medication is put into a single pill. Don’t be concerned if you are taking fewer pills than someone you know, as long as what you are taking includes at least three medications.

Are you getting out soon?

After you are released, the prison will no longer provide your care. It is important that you continue to find treatment for your HIV.

In order to avoid running out of your medicine, put in a request to see a prison social worker and write to an HIV clinic in the area where you intend to live. If you have a parole officer, they may also be able to help.

If your care is interrupted between when you are inside and when you come home, the number of copies of your virus will start to go up as soon as you stop taking your pills. This can increase the risk of transmission to others. HIV is usually spread by having anal or vaginal sex, or by sharing drug injection equipment. Consistent HIV care can help you protect your own health and the health of those you care about.

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