Highly Active Antiretroviral Therapy (HAART) is a form of combination therapy involving three or more antiretroviral (ARV) drugs in a daily regimen to treat HIV infections and AIDS.
Timing and Dosage
There is no textbook formula on the best time for an HIV+ individual to begin HAART. Generally, it is prescribed when the CD4 cell count is 200 – 350 per cubic millimetre of blood and administered prior to the advanced stages of the infection.
Since ARV medications are most effective when used for the first time, it is critical to get the combination of drugs right upon commencement of HAART.
Commitment and Adherence
Once HAART is started, it has to continue for the rest of the patient’s life, so he/she must be totally committed to the drug regimen. It is demanding on the patient’s daily life and routine because he/she has to adhere strictly to the doctor’s prescription for:
- Types of drugs to take for each dose.
- Quantity of each type of drug to take for each session.
- Exact timing of each dosage.
- Frequency of taking the drugs throughout the day.
At times, due to various reasons such as appearance of side effects or ineffectiveness of prescribed drugs, some patients interrupt treatment temporarily. Known as a Structured Treatment Interruption (STI) or drug holiday, it can be beneficial in terms of lowering the level of toxicity in the body and improving the patient’s quality of life by freeing him/her from adherence to the daily medical regimen. Psychologically, having a drug-free break improves adherence when HAART is restarted.
A patient undergoing HAART should never skip or stop medication unsupervised or on a random basis. Doing so not only undermines the effectiveness of the therapy, it can do more harm than good to the body and may limit possible treatment options in future.
Always consult the doctor first and work out a proper time scale for STI. Make sure that there is close supervision and support from the doctor throughout the period.
Side Effects
As with any drugs, ARV medications have known side effects, the most common being nausea, diarrhea and sense of fatigue. Side effects are graded according to the following range:
- Mild - e.g. having two to three vomiting episodes a day.
- Moderate
- Severe
- Life-threatening - e.g. extreme limitations on daily activities and need for hospitalization.
When choosing drugs for HAART, common side effects have to be considered, taking into account possible negative impact(s) on the patient’s existing medical condition(s). Be aware of these side effects, although not everyone who takes the same ARV drug will experience the same side effects or experience them to the same extent. The side effects sometimes go away as treatment continues because the body has adjusted to the drugs. Always keep the doctor posted of your situation so that if necessary, an alternative combination of drugs can be prescribed.
About 10% of those beginning HAART will experience Immune Reconstitution Inflammatory Syndrome (IRIS) during the first few months of treatment. The ARV drugs help the patient’s immune system to recover, causing it to respond excessively to pre-existing and dormant opportunistic infections, producing corresponding symptoms. With continued treatment, these symptoms should disappear within a few weeks.
Cost
Depending on the individual’s medical regimen and the types of ARV drugs prescribed, the cost can range between US$900-$2000 a month. Those facing financial difficulties can check with their local health or HIV/AIDS organizations to seek financial support.
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