HIV: you’ve achieved viral suppression, now what?

The first and most important step to take after being diagnosed with HIV is to start treatment as early as possible.

HIV (human immunodeficiency virus) causes a chronic viral infection that attacks and destroys the body’s white blood cells, which are needed to fight infections. Over time, this greatly reduces the number of white blood cells in the body, leaving it unable to fight off opportunistic infections and cancers.

The treatment for HIV is called antiretroviral therapy (ART). These drugs work by disrupting the lifecycle of the virus and stopping it from replicating. This allows white blood cells to remain at a normal number. It also allows the immune system to remain healthy and prevents transmitting HIV to others.

The goal of treatment is to reduce the viral load—the amount of virus in the body—to undetectable levels and keep it there. This is called viral suppression.

If you are living with HIV, taking medications, and your viral load is undetectable, you might be asking yourself what happens next. Here are two questions to ask yourself, that you may want to discuss with a healthcare provider.

How is your overall health?

When you’re living with a chronic condition like HIV, that chronic condition can feel all-consuming. And while treating HIV is arguably the most significant factor in keeping you healthy, there are many other factors that you need to consider.

With treatment, people with HIV can live long, healthy lives. Consequently, they have to pay serious attention to the health concerns that people face as they begin to approach older age—such as cardiovascular disease, diabetes, kidney disease, and cancer.

These conditions are common among the general population. They may be more common among people with HIV and occur at younger ages, for reasons not yet fully understood.

Overall health also includes mental health. Living with a chronic illness can be stressful. People with HIV are at a higher risk of mood disorders like depression. HIV infections can also affect the nervous system, including the brain.

It’s important to be proactive in taking care of your overall health and mental health—and it’s never too early or too late to start. If you’re not sure where to begin, talk to your healthcare provider about your cholesterol levels, blood pressure, blood glucose, and other important biomarkers.

Your healthcare provider can also keep you up to date on vaccinations, routine screenings, and refer you to other specialists if needed.

How do you feel about your treatment plan?

To be effective, ART must be taken consistently. Missing doses or taking doses inconsistently can lead to treatment failure and cause the infection to become resistant to the medications you are taking—which will make treatment more difficult and less effective.

ART must also be taken indefinitely. Because it will be taken indefinitely, adhering to your treatment plan may be easier at some times than others. It’s best to identify anything you find difficult or challenging about your treatment plan as early as possible—and address any potential problems as early as possible. This list might include:

• Side effects. If you haven’t already, talk to your healthcare provider about the potential side effects of the medications you are taking. Any changes in how you feel—physically or mentally—should be discussed with a healthcare provider immediately.
• Drug interactions. These can be difficult to distinguish from side effects. Make a list of any medications and supplements you take (including any herbal supplements) and share it with your healthcare provider. This will also be helpful if you are prescribed a treatment for another health condition.
• Prescription costs. Monthly prescriptions can be expensive, and you want a plan in place in case you change jobs, switch insurance, or have to cope with a period of unemployment. This is true of HIV medications as well as medications for other health conditions.

No challenge or difficulty is too small to discuss with a healthcare provider. Even something that seems simple—like remembering to take your medication at consistent times—can seriously impact your treatment.

There are numerous ART medications available, and more under development. One example is long-acting ART drugs, which are delivered as monthly shots instead of daily oral medications. The first became available in December 2021.