Finding a healthy formula

HIV is a serious health issue. Left untreated and the results can be devastating.

Fortunately, we now understand the best ways to treat and manage HIV. This means that with a little effort, we can all live long and healthy lives.

The formula for good health is pretty universal. It includes regular health checks, eating well, taking exercise, getting adequate sleep, limiting our alcohol and other drug use, and not smoking.

But for those of us living with HIV, the formula must also include the right HIV treatment.

What is the “right” treatment?

There are so many different HIV treatments available today that everybody is now able to find a combination that is right for them.

Some decisions will be based on whether you have a pre-existing medical condition. Others will be determined by your body’s individual characteristics. Everyone is different and some people respond better to certain treatments than others.

The first priority of treatment is to suppress HIV and to achieve an undetectable viral load. It will also reduce inflammation, protect you against opportunistic infections, preserve your immune system and brain function, and make it virtually impossible for you to pass on HIV.

But treatment effectiveness means more than that.  Being on the right HIV treatment is fundamental to good quality of life.

How well does your current treatment fit into you daily life? Is there a better combination than the one you are on? It is completely reasonable to consider changing treatment if you are experiencing any side effects at all.

How important really is one pill a day? Are you prepared to increase the number of pills you take if you’ll feel better for it? Different regimens have different benefits. Prioritise what is important to you.

Your doctor or a treatments officer at an HIV organisation will be able to help you work through your options. Go here for more treatment information.

What the studies show

Some people still worry whether treatments are toxic or really necessary. Be assured that our current knowledge is based on rigorous scientific studies involving thousands of people.

Studies now show that the earlier you start HIV treatment the better your long term health benefits. Starting early reduces the risk of serious illnesses and death, and people who begin HIV treatment early have a better quality of life than those who wait. (See START study results)

Starting treatment soon after seroconversion has added benefits. In its early stages, HIV develops reservoirs in the body and early treatment can reduce these. This is very important if the current trajectory of cure research turns out to be successful. (Visit the HIV Cure website.)

Numerous studies also show that HIV treatment reduces the amount of HIV in your body so well that it is virtually impossible for you to transmit it to another person. (See PARTNER study results.)

Start as you mean to carry on

Starting HIV treatment is a commitment because once you start, you must continue. Stopping and starting treatment may result in developing a resistance to those particular treatments which means they won’t work for you anymore.

Treatment adherence is a challenge. Fortunately, modern HIV treatments are simple to take. Most people find it no hassle at all. They take their treatment with breakfast, when they clean their teeth or just before bed. Others use dosette boxes as a reminder, particularly if they are taking more than a couple of pills. Some people use electronic reminders. Many positive people use friends for support, particularly when they are first starting treatment.

What about side effects?

It is not unusual to have mild adjustment side effects in the first few weeks of starting or changing treatment. These can include headaches, diarrhea, nausea or disturbed sleep. But they normally pass, and many people don’t experience any at all.

Having the support of a friend, especially one who also has HIV, can help during this time. So can the advice of a peer support worker from an HIV organisation.

If your side effects are severe or ongoing, discuss this with your doctor. Some people have to spend a little time trying different combinations until they find one that works for them.


Monitoring your health

Seeing your doctor for regular monitoring is an important aspect of living healthily with HIV.

Having your blood tested every four months will tell you whether your HIV treatments are working.

But these tests measure more than your CD4 (T cell) count and viral load. They also check other levels such as liver function and cholesterol so you can pick up any irregularities early.

Other tests will depend on your age and sex, and these may include prostate exams for older men and Pap smear tests for women.

Testing for other sexually transmitted infections is another important part of monitoring. Remember: the more sex you have, the more you should get tested.

Eating well

A healthy diet is really a form of co-therapy to optimise your health. You need to eat at least three healthy meals a day to control you blood sugar. Eating well will give you short term energy and improve your long term health.

Choose a variety of nutritious foods from the five food groups every day:

  • Vegetables of all different types and colours
  • Fruit, particularly those that are fresh and in season
  • Grains, including breads, cereals, rice, pasta and oats
  • Lean meat, fish, eggs, tofu, nuts, seeds and legumes/beans
  • Milk, yoghurt, cheese and/or their alternatives

Remember to drink plenty of water and limit your alcohol.  Also, avoid sugar, salt and unhealthy fats including those hidden in processed foods.

A good, balanced diet doesn’t usually need any supplements. But if you are considering taking any vitamin, mineral or herbal supplement, talk to your HIV doctor as some of these can interact with your HIV treatment.

Good sleep

Not getting enough sleep can make you feel awful. Long term it can cause serious problems. Sleeping too much can also make you feel tired and reduce your motivation to do anything else. If you have trouble sleeping, experts recommend using your bed only for sleeping (and sex, of course). That means no TV or computer screens in the bedroom.

Try to spend an hour or so before bed winding down and relaxing. This might include watching TV in another room or reading a book; but avoid computers, smart phones or other tablets.

If anything is troubling you, jot it down on a piece of paper. This will help you to leave those thoughts until the next day.

Try going to bed at a similar time each night. And if you can’t sleep, get up for a short period and do something monotonous like ironing a shirt or watering your plants.

Sleep experts also recommend getting some exercise during the day, preferably outside and in the daylight.

If you can’t sleep or may be sleeping too much, talk to your doctor. They can help you work out if you have any underlying health issues.

Sleeping pills can be useful if you are managing a difficult or stressful event but they can become less effective when used long term.


Exercise regularly

Exercise helps you sleep better at night and gives you more energy during the day.  And the chemicals it releases in the brain can leave you feeling more relaxed and happy.

Exercising reduces the risk of heart disease, stroke, type 2 diabetes and osteoporosis; all of which are more common among people with HIV.

Experts recommend at least 30 minutes of physical activity on most days. If you want to really increase your fitness or lose weight, you may need to exercise more. If you’re unfit or managing other health issues then speak to your doctor before embarking on any new regime.

Some people run marathons, others walk the dog. Exercise is very different for different people. However everyone can benefit from exercise, including people who are experiencing even severe disability.

If you are starting something new, start slowly at first and build up. Consistency is the key and if time is an issue, plan when and where you can fit in some activity. Some people incorporate exercise into their normal daily activity, like walking or cycling rather than taking the car.

Enjoying exercise

Exercise should not only be a strategy to improve your health. It should also be fun.

Think about the kind of exercise that you will enjoy. Do you like walking or dancing? Would you prefer to play in a team or take a class? Do you want to listen to music or enjoy the fresh outdoors? There are so many different aspects of exercise to enjoy. Think about what will motivate you to keep moving.

Remember there are movement-based exercises, such as yoga and tai chi, which help maintain muscle tone and flexibility while also including meditative or relaxing qualities.

Many people struggle to establish new routines particularly around exercise. Finding the time and motivation takes practice, so don’t punish yourself. Doing any physical exercise is better than doing none at all. Hopefully your improved sense of well-being will be enough to keep you motivated.

People who exercise together have better results. So, think about doing it with a friend. For more ideas, go here.

Is alcohol helping?

People with HIV do not need to avoid alcohol altogether. A little alcohol can be a good thing. But too much can affect your immune system and slow down recovery from infections.

Alcohol is particularly dangerous if you have hepatitis C or other liver disease. There is also research suggesting alcohol and HIV act together to inflame cells which may increase the risk of problems with your brain and heart.

Getting drunk can cause people to forget to take their HIV treatment. It can also alter the way medications are metabolised in your body, which may reduce their effectiveness or cause unwanted side effects. People whose liver has been damaged by drinking alcohol are more likely to experience side-effects from HIV treatment, particularly protease inhibitors.

If you’d like to speak to someone about your drinking, start by talking to your GP.

What about other drugs?

Recreational drugs can be fun. They can also be addictive. And depending on how you use them they can interfere with your relationships, work, finances and health.

For people with HIV there are also additional issues to consider. Any drugs (legal or otherwise) have the potential to interact with your HIV treatments making them less effective. Some HIV treatments will also increase the effect of recreational drugs to unpleasant or dangerous levels. Steroids and some antidepressants can interact dangerously with some recreational drugs.

Like alcohol, while under the influence of drugs, people also risk missing doses of their HIV treatments which can lead to resistance or a peak in viral load.

If you use drugs, minimise your risks by telling your HIV doctor about what you are taking. They may switch you to an HIV treatment that is less likely to interact.

Recreational drug use can cause stress on your body. It can interfere with sleep and diet and impact your physical and mental health. Changing how you use can be difficult if all your friendships revolve around drug use. Reconnecting with family or forming new friendship networks can be very helpful.

If you are concerned about your drug use, start by talking to your doctor or contact an HIV organisation for advice.


Smoking is particularly harmful for people with HIV.

HIV positive smokers are more likely to get oral thrush, hairy leucoplakia (white mouth sores) or bacterial or pneumocystis pneumonia (PCP). Smoking also increases the likelihood of serious lung disease, heart disease, stroke or cancer. People with HIV have double the risk of dying from smoking-related diseases than people who do not have HIV.

Stopping smoking is one of the most important things you can do to improve your health.

You may need to try giving up more than once. Don’t see this as failure. Stopping smoking is difficult precisely because smoking is so addictive. The more you try to stop the better your chances of succeeding.

There are a range of different strategies you can use to help you quit, including nicotine gum, nicotine patches, acupuncture, counselling and hypnosis. You may decide to try more than one.

The more help you get, the better. Talk to your doctor or to the experts at Quitline (Tel: 13 78 48).

If possible, get your friends and family on board for emotional support.

The good news is that if you stop, you will experience health benefits almost immediately. And the longer you stop the greater the benefit.