Holidays half over; treatment plans intact?

Many people are aware that current treatment plans involve a lifetime committment. This means whether once-per-day or twice, whatever combination of medicines is prescribed needs to be taken in the same way at the same time, daily, as instructed.

This can be very challenging during holiday periods: There may be travel involved (which may include time-zone changes); there could be guests visiting or being visited (which might mean a change in how, where and to what degree the prescription-taking is visible to others, and to whom); there may be changes in eating and also drinking patterns (possibly involving parties, dinners, get-togethers and other things) and this combination needs to be accounted for in our holiday planning.

While a great majority of the "rush" of the season is now behind us all, there are still a few more days (almost a week, in fact) when many people are still away, or otherwise not yet returning to normal routines, be they work, school or whatever.

How are you coping? Has it been a challenge? Was there some adjustment? Did it all go well? Were there some rough patches?

Nobody is perfect, for if we were, how "human" would we be? Still, where possible, we must try to give the research and team of healthcare professionals who are literally working on our behalf the best possible outcome they've worked for - and this is not to mention our own selves... for we deserve it - by trying to account for these holiday-period changes and recognizing the challenges, where possible, ahead of time. Planning for that, and doing what we need to do to accommodate these differences in our daily routines, will go a tremendously long way toward the success of our treatment plan and toward better health outcomes for us!

Here is hoping that 2010 is the year when it all comes together, if it hasn't; and here's also hoping that the gains of 2009 improve while the pains lessen in this coming year. To whatever extent we have control over these issues, here's hoping we'll take that control and use it wisely, and that to whatever extent it's out of our hands, we are favoured with nothing but the best!

The Season

At a time in the year when people's thoughts turn to holidays of one kind or another, whether travelling or hosting, whether near or far; regardless of religion or not, and with the emphasis on getting it all done, no matter what that may be (even just stocking up on supplies when things are closed down for so long): How do people cope? How does anyone cope with the rush, the demands, and the resulting stress that is seasonally ours - subscriber or not?

For some, it may be just turning to those they regularly seek out and are with; others may find comfort in finding long-ago (even recent) folks who've moved, been less involved or are otherwise distant. Reducing stress is shown to be of benefit in healthcare settings of all kinds, whether just helping to reduce blood pressure or helping with behaviour changes that reduce risk and include harm reduction measures. Friends, family and even strangers may have it in them to help, but we have to let them or seek it, or at least actively engage. Whatever way one does it, make sure that this holiday season, there is something in your stockings (whether hung or worn) that really helps take stress levels down as much as one can. You'll feel and be better for it!

So, what reduces your stress?

Most important considerations in choosing a regimen?

Anti-retroviral medications have improved, over time, with fewer (and sometimes better-managed) side effects, reduced numbers of required pills and less-frequent dosing.

Choosing the right medication combination is a very personal thing, and even each HIV specialist differs in their approaches: Some will choose a regimen that is very defensible while others prefer different choices. The choice often rests on the individual patient's priorities: Does the number of pills really seem important? For some, even many, it will. Is there any difficulty with varying day-to-day schedules (work, sleep, travel, etc...) making dosing schedules an important consideration. Are there certain other medications already (or likely to be) used to control such things as diabetes, high blood pressure, cholesterol issues (particularly triglycerides)? Interactions with certain medications is an issue. Is there a co-infection with hepatitis B or hepatitis C? This can influence the choice of medication and even the decision to start treatment or not. Is it likely that food will always be available at the specific time when one needs it for the medication (if the medication requires food)? For those who travel and who don't generally eat breakfast, this may influence once-a-day dosing scheduling as well as help decide whether or not once- or twice-a-day is best. And that can also lead to influencing decisions regarding which medication to choose as, for example, efavirenz (Sustiva) is often taken at nighttime in order to help manage certain possible side effects; however, there may be reasons to avoid that medication, so a different one may be needed.

For those folks being recommended to start treatment, these are among the questions that need to be thought out. If they are considered ahead of your appointment with the HIV specialist, a fuller discussion can be had and the result will be a better-tailored medication regimen that will work and that you can adhere to, which is the greatest single factor within our control that can prevent resistance developing by the virus to the medications... and obviously, that will lead to better health outcomes.

Starting Treatment & Patient-centred care

The question about when to start treatment has been a hotly-debated one, and over time, the target has been moving back-and-forth between lower and higher numbers of CD4s as a base for recommending the beginning of antiretroviral use. However, the decision remains a personal one that each individual must make in connection, and after discussion, with his or her healthcare provider. Gone are the days where one simply presents to a doctor with an illness and whatever is handed for treatment is taken without question. Patient-centred care is not only a valid buzzword but also a most necessary part of decision-making: When medications no longer have side effects, when food no longer needs to be taken, when housing and other necessities of life are fully assured, then there might be every reason to follow the doctor's advice without question, but still: You have a choice. Things must be carefully weighed and balanced, both medical considerations as well as personal ones, and the decision remains an individual one. If you need help making such a lifelong committment to treatment, you're not alone; there is support, and there are professonals to speak with who may be able to help with the reasoning process, and other important actions, as well. The take-home message is that one doesn't simply take a strong medical recommendation and follow it blindly without thinking about what it means. It has to be a balanced and thoughtful approach toward treatment. What do folks think about this?

World AIDS Day

Today is World AIDS Day. You may be hearing about funding cuts to HIV community based organizations in the Vancouver area today. How does this affect your health? Programs and services are needed for HIV-positive individuals as each year sees approximately 200-300 new HIV-positive results. What do you think of this? Share your thoughts on this.