Adherence to Antiretroviral Treatment (ART)

If you are living with HIV, one of the biggest lifestyle changes is starting ART and taking treatment for the rest of your life. If you want to stay strong and live a healthy life, you can never stop your treatment. Your body might take some time to adjust to the side-effects of the ARVs, and you will need to remember to always collect your pills in time, so you don't run out, and you have them with you when you need them so you can take your treatment at the same time every day.

What Adherence to ART means

Adherence to Antiretroviral therapy (ART), or taking ARVs exactly as the healthcare worker advises, leads to viral load suppression. This is when ARVs have reduced the amount of HIV in the body so much that it is suppressed and the immune system gets a chance to recover. At this stage, there is so little HIV in the blood that there is less chance of passing it on. Someone living with HIV will also be able to have HIV-negative children by following the correct procedures. Although taking ARVs may be feel like a burden, stick to the treatment. When HIV is suppressed a long, happy, healthy and productive life is achievable.

For ART to be effective it needs to be taken as prescribed by a healthcare worker. This means:

  • Not taking breaks from taking ARVs
  • Avoiding skipping doses.
  • Taking ARVs around the same time every day. Not doing so is as bad as skipping a dose.
  • Taking ARVs with a healthy meal or on an empty stomach depending on the advice from the healthcare worker. This affects how well the ARVs are absorbed into the body.
  • People living with HIV should try to avoid taking other medication that might interfere with their ARVs. It is best to discuss other medicines that are being taken with the healthcare worker at the clinic, even simple pain killers. This includes telling the healthcare worker about any drugs taken socially to get high or alcohol.

Click here for First-line ART Regimens.

Why adherence to ART is important

Achieving Viral load suppression

Viral Load Suppressionis when the amount of HIV in the blood has dropped so much - to less than 50 copies of HIV in a teaspoon of blood - that it cannot be detected by a viral load test. This does not mean that HIV is cured but that there is only a small amount of HIV in the blood. If ART is skipped or stopped HIV will take the chance to grow stronger and attack the immune system again. Viral load suppression is the aim of ART and can only be achieved if you take your ARVs.

Avoiding Drug resistance

When someone first starts taking ARVs they start on first-line treatment. If ARVs are skipped or stopped, HIV multiplies again. When HIV multiplies, it changes its form and makes different versions of itself. HIV can now trick the first-line treatment because the ARVs don't recognise the new HIV. This is how HIV becomes resistant to first-line treatment. Because first-line treatment no longer works to control HIV, second-line treatment is needed. Second-line treatment is stronger and has more side effects. Skipping or stopping on second-line treatment means HIV could become resistant to this treatment too. Third-line treatment is even more complicated, has more side effects and leaves the person with almost no treatment options.
Treatment can only be switched upon instruction from a doctor or a nurse.

Tips for taking ART

Taking ART is a lifelong commitment and that might feel overwhelming sometimes. But there are real steps people living with HIV can take that can help them take their ARVs every day, at the same time, to keep HIV under control and reach viral load suppression:

  • Use a 7-day pill box to keep ARVs organised. Make time once a week to refill the box for the week ahead.
  • Setting an alarm, or a reminder, on a cell phone and taking the ARVs straight away when it goes off.
  • Setting a reminder on a cellphone or using a wall calendar as a reminder to return to the clinic for more ARVs a week before the medication runs out.
  • Choosing a regular daily activity to help remember to take the ARVs, like brushing teeth, or when a favourite TV show starts.
  • Keep a treatment diary. Enter the name of each ARV. Include the dose, number of pills to take, and when to take them. Record each ARV as it is taken.
  • Plan ahead for changes that might be coming up, like weekends, going home or going on holiday. The person taking ART should make sure they have enough ARVs to last the whole time they are away.
  • Get a reliable treatment buddy - someone who can remind the person to take their ARVs.
  • Disclosing - telling someone about their status - can help that person feel loved, accepted and supported.
  • Join or start a support group for people living with HIV. These can be based at clinics, churches , schools and colleges.
  • Join an adherence club at your clinic or in your community.

What if a dose is skipped?
Take the missed dose as soon as possible, unless it is almost time for the next dose. In that case, the next dose must be taken and treatment continued as usual. Never take a double dose to make up for the missed dose!

What if the person vomits after ARVs have been taken?
If someone vomits less than an hour after taking their ARVs, they should take the dose again. If vomiting continues please consult the nurse or doctor.

Should ARVs be taken with or without food?
It is best to take ARVs after a meal but fatty meals should be avoided.

Side effects and ART

ARVs can have side effects. Side effects differ from person to person. Mostly they stop after the first few weeks. If you have bad side effects that last for more than 7 days, do not stop your treatment. It is best to speak to a healthcare about steps that can be taken and medication that can manage the side effects. Sometimes the healthcare worker will swap an ARV in the treatment regimen for a different one that the body handles better.

These are the most common side effects of the ARVs that are available at our hospitals and clinics:

Chemical Name

Brand Name

Nausea
(wanting to vomit)

Headache

Diarrhoea
(Running stomach)

Skin Rash

Extreme tiredness

Dizziness

Other Symptoms

Abacavir

Ziagen

Feeling very tired

X

X

X

X

 
  • Fever

Ritonavir

Norvir

X

X

X

   

X

  • Tingling or numbness around the mouth.

Efavirenz

Sustiva

     

X

 

X

  • Feeling sleepy
  • Trouble sleeping
  • Strange dreams and nightmares
  • Confusion or feeling mixed up
  • Not being able to concentrate
  • Feeling down and mood changes
  • Having visions
  • Loss of memory
  • Confusion
  • Feeling 'stoned'
  • Feeling unusually happy

Emtricitabine

Emtriva

X

X

X

X

   
  • Skin discolouration

Lamivudine

Epivir

X

X

 

X

X

 
  • No appetite
  • Sore stomach

Lopinavir

Norvir

X

 

X

X

   
  • Sore stomach
  • Tingling or numbness around the mouth.
  • Tired feeling
  • Changes in the shape or place where your body fat collects (especially in your arms, legs, face, neck, breasts, and waist).

Nevirapine

Viramune

X

 

X

X

X
(especially women)

   
  • Sore stomach
  • Muscle pain

Tenofovir

Viread

X

X

X

X

 

X

  • Sore stomach
  • Trouble sleeping
  • Feeling down and having mood changes
  • Lipodystrophy: Changes in the shape or place where your body fat collects (especially in your arms, legs, face, neck, breasts, and waist).

FIXED DOSE COMBINATION (FDC) ARVs = 2 or more ARVs in 1 pill

Emtricitabine + Tenofovir

Truvada

X

X

X

X and itching

 

X

  • Feeling down or anxious
  • Sore stomach
  • Trouble sleeping
  • Strange dreams
  • Joint pain
  • Back pain
  • Lipodystrophy: Changes in the shape or place where your body fat collects (especially in your arms, legs, face, neck, breasts, and waist).
  • Changes in the colour of your skin on your palms or the soles of your feet

Lopinavir + Ritonavir

Aluvia or Kaletra

X

X

   

X

 
  • Sore stomach
  • Weakness
  • Lipodystrophy: Changes in the shape or place where your body fat collects (especially in your arms, legs, face, neck, breasts, and waist)

Managing side effects

There are medications to manage some of the side effects common to ARVs, but there are also foods or steps that can be taken that can help. People taking ART should not take any herbal remedies without consulting a healthcare worker.

SYMPTOM

MEDICATION

STEPS TO TAKE

Nausea (feeling sick) or vomiting

Anti-nausea medication

  • Avoid oily or spicy foods
  • Eat dry foods like toast
  • Sip on black tea
  • Drink water with lemon juice

Diarrohea (running stomach)

Antidiarrheal medication

  • Eat very ripe bananas, rice or toast
  • Avoid milk
  • Drink water that contains salt and sugar

Headache

Pain killers

  • Drink lots of water
  • Lie down and put a cold wash rag over your face
  • Massage the base of your skull with your thumbs

Skin rash

Anti-histamines

  • Use a natural soothing cream calamine lotion or castor oil

Loss of appetite

 
  • Eat small meals regularly
  • Eat foods you like even if you aren't hungry
  • Avoid foods that have no nutritional value

Dizziness

 
  • Take your pills before you go to sleep and are lying down.
  • Some people who have nightmares prefer to take their pills in the morning so their sleep isn't interrupted. Either way you need to talk to your doctor about this.

Tiredness

 
  • Go to sleep at the same time every night and get up at the same time every morning
  • Try to avoid alcohol

ABOUT US

The Zenele is an ARV adherence program promotes adherence to ARV treatment and encourages healthy living on ARVS as part of the HIV journey. The campaign utilizes mentors and social media platforms to promote ARV adherence that leads to viral load suppression.

Contact Us

Tel: 012 366 9300
Fax: 012 366 9301

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Physical Address

257 Brooklyn Road
Equity Park (Block D),
Brooklyn
0011
Pretoria
Gauteng

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