According to Dr van Zyl, your doctor or nurse clinician needs to do a proper clinical assessment and baseline blood tests. The goal is to exclude all opportunistic infections before starting a patient on lifelong antiretroviral treatment. Before January 2015, medical professionals suggested starting ARV treatment when the CD4+ count starts dropping and the immune system is failing. Today it’s recommended that ARV treatment be started immediately when a person is diagnosed as HIV positive. Patients who are on antiretroviral drugs need to be monitored for evidence of drug side effects, evidence of clinical response to therapy (climbing CD4+ cell count indicates a recovering immune system), as well as for unexpected worsening of opportunistic infections.

ARVs are Schedule 4 drugs, meaning that have to be prescribed by a medical doctor or a nurse clinician who has been trained to manage HIV treatment. You can get HIV treatment at any public sector health facility in South Africa. If the facility cannot assist you, they will refer you to a facility that can. You can also access treatment via your medical aid. According to Dr van Zyl, all medical aids in South Africa are obliged to cater for HIV/Aids. The benefits will come from a separate fund for which you do not pay extra. If you are on medical aid, please make sure to ask your scheme how you can be registered on the programme. If you are a cash patient, look for a doctor who is familiar with or who specialises in HIV. Do not hesitate to ask Dr van Zyl any questions directly on Health24.

"Most people will start the same first-line regimen, especially in the public health sector," says Dr van Zyl. The private health sector has different options determined by the treatment prescribed by your doctor.

According to Dr van Zyl, your doctor or nurse clinician needs to do a proper clinical assessment and baseline blood tests. The goal is to exclude all opportunistic infections before starting a patient on lifelong antiretroviral treatment. Before January 2015, medical professionals suggested starting ARV treatment when the CD4+ count starts dropping and the immune system is failing. Today it’s recommended that ARV treatment be started immediately when a person is diagnosed as HIV positive. Patients who are on antiretroviral drugs need to be monitored for evidence of drug side effects, evidence of clinical response to therapy (climbing CD4+ cell count indicates a recovering immune system), as well as for unexpected worsening of opportunistic infections.

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Unfortunately there are different side-effects associated with different ARVs, but these vary from person to person. Side-effects can range from mild to severe – nausea, diarrhoea and fatigue are common side-effects that people experience. There are other less common side-effects such as mood fluctuation. According to Dr van Zyl, Efavirenz causes the most side-effects. Most people experience dizziness, nightmares, sluggishness, and some people even get depressed. These symptoms are short-lived but if they persist please let the doctor or nurse clinician know. There are other options. "We do not want shift workers on Efavirenz because of the drowsiness and dizziness, so do let the doctor or nurse clinician know if you are a shift worker (policeman, doctor, nurse, pilot etc.)," states Dr van Zyl.

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