How does combination therapy work?

HIV treatment prevents the virus from multiplying in the body.

It works like this: in order to replicate, HIV enters certain human cells and takes control of the cell. Instead of producing new human cells, the cell now creates new HIV viruses. Some drugs prevent the virus from entering the cell in the first place. Others prevent HIV from taking command of the cell. And still others prevent the cell from producing new viruses.

One drug alone is not enough, as the virus produces many different versions of itself in the replication process. Different drugs work (or don’t work) against each of the variations of HIV.  

But if you take several different drugs, they attack HIV more effectively. The drugs stop the virus with combined force. This method is called combination therapy.

Beginning treatment

When to start treatment with anti-HIV drugs depends largely on two blood test results. The "viral load" indicates how high the level of the virus is in the blood. The number of helper T cells makes it possible to estimate how badly the virus has already weakened the body's immune system (see treatment recommendations ).

As long as there are no signs of illness, treatment is usually started when viral load is 50,000 to 100,000 (the amount of HIV in 1 milliliter of blood), or when the number of helper T cells drops to less than 350 per microliter of blood (see also laboratory  values).

In order for treatment to be effective, it's important that it is not started too late. But the right time to start treatment will differ from person to person. Doctors who specialize in treating HIV are the best people to talk to in order to answer the question as to when to begin treatment.

Breaks in treatment

There may be times when HIV-positive people need or would like to stop taking anti-HIV drugs for a period of time; for example, because they are traveling.

That's understandable, but a break in treatment can affect how well your treatment works; as soon as you stop taking anti-HIV drugs, the virus begins to spread in your body once again. If your immune system has already been damaged, pathogens which cause illnesses can easily attack once again.

But that's not all: after you stop taking anti-HIV drugs, some of them remain in your body for a while. This amount is not enough to stop the replication of the virus, but it can lead to drug resistance developing. If you start taking the same medication again after a break in treatment, it's possible that those drugs will no longer work.

Breaks in treatment should always be discussed with your doctor first.

HIV specialist doctors

Medical treatment of HIV is complex. A doctor needs to understand the interrelation between HIV and other processes in the body, to be able to interpret blood values, to choose the best anti-HIV drugs for you and to know about recent developments in research. Only specialists can do all of that. HIV specialist doctors are called "Schwerpunktärzte" in German.

If you have received a positive test result, you should look for an HIV specialist practice ("Schwerpunktpraxis") or an HIV outpatient clinic at a hospital as soon as possible. It is worth traveling some distance to visit a specialist. It has been proven that people with HIV do better when they are treated by specialists.

As a rule, it is only necessary to be examined in a specialist practice about 4 times a year.

The nearest AIDS service organization can help you find a specialist practice.

Taking your treatment properly

Treatment for HIV only works effectively when it is taken regularly and at the right time. With some drugs, you may also need to follow some dietary requirements. Some drugs have to be taken on an empty stomach; others should be taken with a meal, for example.

If you don't take your drugs in the right way, it's possible that too little of the active ingredients will enter your body. HIV will start to reproduce itself again, and resistance can develop.

Studies have shown that it is important to take at least 95% of your pills at the right time. That means that you shouldn’t miss more than three doses a month of drugs taken twice a day. If you only take your drugs once a day, you shouldn’t miss more than one dose a month.

How well you stick to the taking your treatment properly will partly depend on your lifestyle. A good HIV specialist doctor will take that into account when choosing a treatment combination for you.