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HIV TREATMENT

Highly-active antiretroviral therapy (HAART) is the treatment of HIV using a combination of antiretroviral medication. HAART does not cure HIV, but it controls the virus, stops it from replicating in the body, and reduces the number of viruses that stay in the body to an undetectable level.

HAART has improved by leaps and bounds over the decades, and people living with HIV are offered treatment options that are extremely effective, reduces the likelihood of them spreading the virus to other people, and help to ensure that they can live as healthily as people without HIV. HIV/AIDS is no longer an untreatable condition with HAART – rather, it has become a chronic condition that is easily manageable.

HAART AND YOUR DOCTOR

First-line HAART medication is available free of charge through the government healthcare system for all Malaysian citizens. Initial and follow-up consultations, as well as medication dispensing services are available at hospitals and Klinik Kesihatan throughout the country.

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If you are screened positive at a clinic, you may be recommended a list of hospitals or clinics to go to as part of your post-test counselling session, or you may choose a facility that is convenient for you.

Before you are indicated as a candidate for HAART treatment, you will have to undergo a blood test that confirms if you are HIV positive. You will be given a hospital referral for this blood test by the clinic where you did your rapid test.

If you are diagnosed HIV positive, your doctor will likely suggest that you go on HAART immediately. The quicker you start on HAART, the faster it will take to get the virus under control, and the better it will be for you in the long run. 

Some doctors may assess your readiness to go on treatment according to certain criteria, such as any issues regarding adherence or the availability of healthcare facilities near you.

HAART treatment is always done under doctor supervision, so it’s necessary that you attend all your appointments. A visit to your doctor may include:

  • a discussion to bring your doctor up to date on your condition;
  • blood tests for white blood cell (WBC) count, viral load (VL), liver and kidney function, and STIs;
  • a chest X-ray to check for tuberculosis (TB) of the lungs;
  • other tests and checks to look at any other conditions.

Your doctor may also choose to monitor your condition for a period of time before putting you on HAART. If this is the case, it’s very important that you work very closely with your doctor to make sure that you can start HAART at the right time.

STAYING ON HAART

For HAART to be effective in controlling HIV, it’s very important that you stay on your medication.

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This includes:

  • Taking them regularly at the same time of day;
  • Not skipping any doses;
  • Bringing them with you for when you need them, such as at work, on leisure activities, and when you travel.

Adjusting your routine to HAART when you’re newly on it can be difficult, but with proper reminders, it will easily become a habit for you. One way to ensure that you don’t forget to take them at the right time is to set an alarm for the time you usually take them.

When you first go on HAART, you may experience some side effects. Some common ones include:

  • Anemia;
  • Diarrhoea;
  • Dizziness;
  • Fatigue;
  • Insomnia;
  • Headaches;
  • Vomiting;
  • Nausea;
  • Rashes;
  • Vivid dreams;
  • Problems with your nerves.

They can be unpleasant, but they are completely normal when first starting HAART – your body will eventually get used to it, and you will no longer experience them.

If you’re experiencing severe or prolonged side effects, do not skip or stop your medication without consulting your doctor. Schedule an emergency appointment with your doctor or visit a hospital’s emergency department, who will advise you on how to continue.

If you find that you have problems adhering to the medication, speak to your doctor, counsellor or pharmacist about it – they’ll be able to help you make adjustments to fit HAART into your routine.

BEING UNDETECTABLE

The goal of HAART treatment is to bring the level of HIV in your body to levels that cannot be detected by standard viral load tests. This is normally below 50 copies of HIV per millilitre of blood – considering that the numbers can go into the millions in an untreated person, this is a huge difference!

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Once you reach these levels, you’re considered “undetectable,” and if you can maintain undetectable status for more than six months, it means that your medication is working well. Without much of the virus in the blood, its effect on the body is dramatically reduced – the virus is less able to attack white blood cells in the blood, which means that there will be less damage to your immune system.

People who are undetectable do not transmit HIV to others through sex, even when doing it unprotected – this is what “Undetectable = Untransmittable” (U=U) means1. In three large-scale studies of couples with different HIV statuses, no transmission of HIV occurred at all from an undetectable HIV-positive person to their negative partner.

An undetectable viral load can only be achieved through long-term adherence to HIV medication. If treatment is not properly maintained, you’ll run the risk of HIV increasing again to detectable levels, and of developing resistance to treatment.

Maintaining this status will allow a person with HIV to live just as well and as long as a HIV-negative person. That being said, it’s always well advised to keep yourself and others safe by using protection and regularly testing for STIs, as you may still be exposed to them even though you are undetectable.

1UNAIDS

HAART AND YOUR WELL-BEING

Maintaining undetectable status isn’t just about adhering to HAART – it also encompasses taking good care of your general health and wellbeing.

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Find time in your routine to engage in physical activity, consume a healthy and balanced diet, learn to manage stress and your mental wellbeing, and avoid consuming alcohol, tobacco and recreational drugs. Read more about it here.

Remember that even if you’re undetectable, it doesn’t mean that you are protected from STIs such as gonorrhoea, chlamydia and syphilis! Always remember to use condoms when having sex, as they are the only way to protect yourself from other STIs. Read more about condoms here.

Being HIV positive unfortunately puts you at higher risk of catching a co-infection, such as tuberculosis (TB) and hepatitis B and C. While these infections are curable, they can affect a HIV positive person severely if left untreated. If you’re concerned about such infections, discuss it with your doctor – they will be able to help you identify any co-infections, and treat them as necessary. Read our fact sheet on TB and hepatitis B and C co-infections.

A close relationship with your doctor is very important and helpful in ensuring that you’re on the right track for treatment. If you need professional opinions, have a chat with your doctor or look for a clinic using our Clinic Finder.

FREQUENTLY ASKED QUESTIONS

What is HAART?

Highly-active antiretroviral therapy (HAART) is the treatment of HIV using a combination of antiretroviral medication.

Are ART and ARV the same thing as HAART?

Yes! ART stands for “Antiretroviral Therapy,” and ARV stands for “Antiretrovirals” – both of them refer to HAART.

Is there a cure for HIV?

At this moment, while much research is being done to find a cure for HIV, there is still no known cure. HAART does not cure HIV, but it controls the virus, stops it from replicating in the body, and reduces the amount of viruses that stay in the body to undetectable levels.

What medications are used as HAART?

Depending on your condition, your doctor will prescribe a combination of the following types of medication:

Nucleoside analogue
reverse-transcriptase
inhibitors (NRTI)
● Abacavir (ABC)
● Didanosine (DDI)
● Emtricitabine (FTC)
● Lamivudine (3TC)
● Stavudine (D4T)
● Tenofovir alafenamide (TAF)
● Tenofovir disoproxil fumarate (TDF)
● Zidovudine (AZT)
Non-nucleoside reverse-
transcriptase inhibitors
(NNRTI)
● Efavirenz (EFZ)
● Etravirine (ETR)
● Nevirapine (NVP)
● Rilpivirine (TMC278)
Integrase inhibitors (INSTI) ● Dolutegravir (DTG)
● Elvitegravir (EVG)
● Raltegravir (RAL)
Protease inhibitors (PI) ● Darunavir (DRV)
● Lopinavir (LPV)
● Ritonavir (RTV)
Pharmacokinetic booster ● Cobicistat
Nucleoside analogue
reverse-transcriptase
inhibitors (NRTI)
● Abacavir (ABC)
● Didanosine (DDI)
● Emtricitabine (FTC)
● Lamivudine (3TC)
● Stavudine (D4T)
● Tenofovir alafenamide (TAF)
● Tenofovir disoproxil fumarate (TDF)
● Zidovudine (AZT)
Non-nucleoside reverse-
transcriptase inhibitors
(NNRTI)
● Efavirenz (EFZ)
● Etravirine (ETR)
● Nevirapine (NVP)
● Rilpivirine (TMC278)
Integrase inhibitors (INSTI)
● Dolutegravir (DTG)
● Elvitegravir (EVG)
● Raltegravir (RAL)
Protease inhibitors (PI)
● Darunavir (DRV)
● Lopinavir (LPV)
● Ritonavir (RTV)
Pharmacokinetic booster
● Cobicistat

Source: National Pharmaceutical Regulatory Agency, Ministry of Health Malaysia

Each combination may come in individual pills, or in one single tablet containing two or more medications from the above list. These individual tablets and combination tablets have many brand names, so it’s important that you familiarise yourself with each one!

Does HAART have any side effects?

As with all kinds of medications, HAART may cause some initial side effects which will go away as your body gets used to the medication. Some common side effects include:
● Anemia;
● Diarrhoea;
● Dizziness;
● Fatigue;
● Insomnia;
● Headaches;
● Vomiting;
● Nausea;
● Rashes;
● Vivid dreams;
● Problems with your nerves.
If you’re experiencing severe or prolonged side effects, do not skip or stop your medication without consulting your doctor. Schedule an emergency appointment with your doctor, who will advise you on how to continue.

Where can I find HAART? How much does it cost?

First-line HAART medication can be accessed free for Malaysian citizens, at government clinics and hospitals around the country. You will need a referral letter from a clinic before you can get free access.

If you require second-line HAART medication, the government subsidises half of the cost – you can expect to pay RM700-RM1000 for a monthly supply of your prescription.

In the event that you have to progress to third-line HAART medication, note that it is not subsidised by the government so you will have to pay the full amount.

What happens if I forget to take my medication?

It is important that you remain adherent and take your medications around the same time every day. If you do not adhere regularly with your medications, there is a risk of the virus becoming resistant to your current medication. Once the virus is resistant, you have no choice but to switch medications.

If you accidentally forget to take your medications, don’t panic! Just take it immediately when you remember. If it is close to the time for your next dosage, then skip that dose, and continue with your normal dosage, on the time it is due.
Do not double your dosage to replace the missed dosage.

What do I have to do to get HAART treatment at a government health care facility?

The process to obtain HAART treatment at a government facility involves several steps. The initial process may be long and drawn out, but after this initial stage passes, the follow-ups will be much easier.

Step 1: If you test positive at a private or government clinic, the doctor or medical officer in charge will provide a hospital referral letter.
Step 2: Call the hospital’s Infectious Diseases (ID) Clinic to enquire when you should come for your first visit.
Step 3: Bring your IC and referral letter with you on your first visit. The clinic staff will create a hospital record and ask you to register at the outpatient registration counter.
Step 4: When the registration staff have taken note of your attendance, you will be seen by a counsellor to discuss your diagnosis. While waiting, you will undergo a height, weight and vital signs measurement as well as a blood test.
Step 5: After the counselling session, you will be referred to a doctor. The appointment could be immediately after, or the staff will schedule one on a later date.
Step 6: When you see the doctor, you will have the opportunity to discuss your diagnosis and treatment with them. The doctor may write a prescription for medication, order a blood test or medical imaging procedure, and schedule your next follow-up appointment.
Step 7: Head to the hospital pharmacy to obtain your prescription. You’re allowed to leave after obtaining your prescription.
Step 1: If you test positive at a private or government clinic, the doctor or medical officer in charge will provide a hospital referral letter.
Step 2: Call the hospital’s Infectious Diseases (ID) Clinic to enquire when you should come for your first visit.
Step 3: Bring your IC and referral letter with you on your first visit. The clinic staff will create a hospital record and ask you to register at the outpatient registration counter.
Step 4: When the registration staff have taken note of your attendance, you will be seen by a counsellor to discuss your diagnosis. While waiting, you will undergo a height, weight and vital signs measurement as well as a blood test.
Step 5: After the counselling session, you will be referred to a doctor. The appointment could be immediately after, or the staff will schedule one on a later date.
Step 6: When you see the doctor, you will have the opportunity to discuss your diagnosis and treatment with them. The doctor may write a prescription for medication, order a blood test or medical imaging procedure, and schedule your next follow-up appointment.
Step 7: Head to the hospital pharmacy to obtain your prescription. You’re allowed to leave after obtaining your prescription.

 

I’m HIV positive – how can I attain undetectable status?

For almost all HIV positive people, the only way to achieve an undetectable viral load is to get treatment, and to stay on it. This is where HAART comes into play.

When a person is newly diagnosed, the initial goal of treatment is to start them on medication. This normally happens as soon as your initial condition is assessed by the doctor handling your treatment – you can expect to get your first HAART prescription in a matter of two weeks to a month after your initial diagnosis.

Once you begin HAART treatment, you will have to continually be on it, as well as to maintain diligence in adhering to your treatment. If the HAART regime prescribed by your doctor is proven to work well in the long run, the medication will work to reduce your viral load to below 50 copies per millilitre of blood – which is below the detectable range for many standard viral load tests.

Some doctors may choose to withhold HAART until the amount of CD4 white blood cells per cubic millilitre drops below 500 counts. If this is your situation, it’s very important that you work closely with your doctor to keep track of this.

What happens when I become undetectable?

If you’re currently undetectable, congratulations! It means that HAART is working well for you. Now the task at hand is to stay on treatment, to attend all your necessary medical appointments, and to make some lifestyle changes to maintain your undetectable status.

When you become undetectable, it means that the amount of HIV in your blood has reduced to such a low amount, it’s no longer detectable in viral load tests. When there’s very little of the virus in the body, its negative effect on the immune system is dramatically reduced.

If you’ve been undetectable for six months or longer, and are adhering well to your medication, you can be sure that you will not transmit HIV sexually, even when having unprotected sex.

How do I maintain my undetectable status?

For you to maintain your undetectable status, you must stick to your HAART medication. That’s the most important part of HIV treatment – if you do not stay on HAART, the virus may begin to develop resistance to medication and start multiplying again in your body.

Alongside maintaining HAART, you could also make changes to your lifestyle to keep your immune system strong. Among others, these changes could be adopting a workout routine, eating healthily, reducing stress, practicing mental mindfulness, and reducing or stopping tobacco use, alcohol consumption, or recreational drug use.

If I'm undetectable, does it mean I'm cured of HIV?

No. HIV is a chronic health condition – once you are infected, the virus stays in your body permanently. HAART stops HIV from replicating in the body, but it doesn’t cure it.

You may be tempted to begin skimping on HAART once you become undetectable – you should never do this! Not maintaining adherence to your medication may cause the virus to develop resistance to it.

Should I worry about catching STIs if I'm HIV positive and undetectable?

Absolutely – in fact, your body needs the attention more than ever!

Being treated for HIV doesn’t mean that you’re also being treated for STIs. An STI can infect you without showing any symptoms, and may severely affect an HIV positive person if left untreated. Therefore, it’s very important that you always keep track of your STI status through regular check-ups.

If the doctor monitoring your condition does not include regular STI testing as part of your treatment routine, you can always do them at your own accord. Just be sure to get tested at least once every six months, and more frequently if you have a lot of casual partners, having bareback sex, or practicing chem fun (CF).

Is it okay for me to skip protection when I have sex if I'm undetectable?

When you’re undetectable, the risk of you transmitting HIV through sex is non-existent, even if you’re having unprotected sex.

That being said, before you skip protection, make sure that you have been undetectable for at least six months, are regularly taking your medication, and are clean from STIs. Remember to be aware of the risk of catching STIs from your sexual partner(s) too.

What’s my risk of catching other illnesses if I’m HIV positive?

A HIV infection can put you at risk of catching a co-infection, which takes advantage of the weakened immunity caused by HIV to attack your body. People who don’t have HIV can get them too, but the impact of a co-infection on your body can be more severe as your immune system might not be strong enough to fight back.

Being on HAART dramatically reduces the risk of getting a co-infection, but those on HAART may sometimes be infected with a co-infection. For this reason, it’s important that a person living with HIV is familiar with the most common co-infections such as tuberculosis (TB) and hepatitis B and C, and to work with their doctor to prevent or treat them.

Some doctors may suggest that you go on isoniazid preventive therapy (IPT). Isoniazid is an antibiotic used for treating TB infection and disease, but is also taken by people who do not have TB as a way to protect themselves from being infected.

Read our fact sheets on co-infections here:
HIV and Tuberculosis (TB)
HIV and Hepatitis B and C

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