Under ideal circumstances, once a person begins treatment for HIV (human immunodeficiency virus), treatment will continue uninterrupted. But circumstances are often not ideal. Treating HIV is a lifelong process and interruptions happen.
Some interruptions are planned—and are done under the guidance of a healthcare provider. Other interruptions are unplanned. If you have had an unplanned interruption in HIV treatment, restarting treatment as soon as possible is essential to protecting your health and the health of those around you.
When treatment is interrupted, the viral load can increase. When the viral load increases, the infection becomes active. An active HIV infection can damage the immune system, make a person sick, and spread more easily to other people.
Here, we look at three questions to answer when restarting treatment for HIV after an unplanned interruption.
Is the HIV infection drug-resistant?
First and foremost, do not restart treatment for HIV on your own—you should always work with a healthcare provider.
HIV is treated with antiretroviral therapy (ART). These are powerful medications that can suppress—but not cure—an HIV infection. A person will take a combination of different ART medications that attack the virus in different ways. A combination of ART medications is called a regimen.
For ART medications to work, they need to be taken exactly as prescribed. This means taking every dose as scheduled. Taking ART medications inconsistently can contribute to drug resistance, where certain medications are no longer effective at controlling the HIV infection.
Your healthcare provider will order blood tests to determine if the HIV infection has become resistant to any ART medications. This is called drug-resistance testing. Drug resistance testing is typically done before the initial treatment of HIV, when switching treatments, and when restarting treatment. Drug-resistance testing helps identify what medications will or will not be effective against an HIV infection.
Do you need a different healthcare provider?
When restarting treatment, you may want to continue working with a healthcare provider who has treated you in the past, or you may decide to find a new healthcare provider.
Some people have negative experiences with the healthcare system or with specific healthcare providers. Feeling judged or stigmatized by a healthcare provider can make a person reluctant to ask questions—and it may mean they begin treatment without clear instructions or a clear understanding of how treatment works.
If you’ve had negative experiences with the healthcare system or specific healthcare providers, restarting treatment can be an opportunity for a fresh start. Spend some time thinking about what you need from a healthcare provider and read about how to find a healthcare provider to treat HIV.
What caused the interruption?
You’ll want to identify and think about what caused the interruption in treatment. This can help you avoid a similar interruption when you restart treatment. Unplanned interruptions in HIV treatment happen for many different reasons. Some common examples include:
- The out-of-pocket costs of the prescription were too expensive.
- The medication was causing side effects.
- The medication instructions were not clearly explained when beginning treatment or the dosing schedule was too complicated.
- Life circumstances, such as the loss of employment or housing, family responsibilities, or medical emergencies.
- Mental health disorders, such as depression, anxiety, and substance use disorders.
Spend some time thinking about the reason or reasons for the unplanned interruption in treatment. In some cases, the answer might be straightforward. In other cases, it may be a combination of different factors. Writing about your experience can help.
This is one of the most important topics to discuss with the healthcare provider who will be treating you for HIV going forward. While it’s important to restart HIV treatment as soon as possible, it’s also important that you are ready to restart treatment. You want to do everything possible to avoid another interruption.
Sources: Gueorgui Dubrocq and Natella Rakhmanina.... + 15
- Gueorgui Dubrocq and Natella Rakhmanina. Antiretroviral therapy interruptions: impact on HIV treatment and transmission. HIV/AIDS - Research and Palliative Care, 2018. No. 10.
- HIV.gov. HIV/AIDs Glossary: Structured Treatment Interruption.
- HIV.gov. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.
- U.S. Department of Veterans Affairs. HIV: Frequently Asked Questions.
- UpToDate. Patient education: Initial treatment of HIV (Beyond the Basics).
- National Institutes of Health. HIV Treatment: The Basics.
- Centers for Disease Control and Prevention. ART Adherence.
- Centers for Disease Control and Prevention. HIV Treatment.
- Stanford Medicine. HIV Drug Resistance Testing.
- HIV.gov. Drug Resistance.
- Luna Dolezal. Shame anxiety, stigma and clinical encounters. Journal of Evaluation in Clinical Practice, 2022. Vol. 28, No. 5.
- Marya Gwadz, Charles M. Cleland, et al. Stopping, starting, and sustaining HIV antiretroviral therapy: a mixed-methods exploration among African American/Black and Latino long-term survivors of HIV in an urban context. BMC Public Health, 2021. Vol. 21.
- Linda Beer, Yunfeng Tie, John Weiser, and R. Luke Shouse. Nonadherence to Any Prescribed Medication Due to Costs Among Adults with HIV Infection — United States, 2016–2017. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR), 2019. Vol. 68, No. 49.
- HIV.gov. HIV Medicines and Side Effects
- Simona A. Iacob, Diana G. Iacob, and Gheorghita Jugulete. Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment—Clinical Points of View and Practical Considerations. Frontiers in Pharmacology, 2017. Vol. 8.
- Patricia de los Rios, Chinyere Okoli, et al. Prevalence, determinants, and impact of suboptimal adherence to HIV medication in 25 countries. Preventive Medicine, 2020. Vol. 139.
