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Introduction to combination therapy - June 2008
Contents. 
Children. 
Age 
Early
and late diagnosis.
Treatment guidelines do not yet comment on this apart from in reference to heart disease.
Combination therapy may reactivate an important part of your immune system called the thymus. Previously, most doctors thought it stopped working in adolescence.
The thymus may become active again in people in their 30s who are HIV-positive and using combination therapy. This finding isn’t yet fully understood. It may mean that there are advantages to starting treatment when in your 20s or 30s.
Ageing suppresses our immune systems and reduces our CD4 count. People over 50 have an increased risk of damage caused by HIV. The argument for starting treatment probably gets stronger as you get older.
An assessment of cardiovascular health should be made before starting HIV treatment.
Risk factors for heart disease include age (over 45 for men and over 55 for women), sex (male), lack of exercise, family history of heart disease, high blood pressure, smoking and diabetes.
Other risk factors associated with heart disease include raised levels of cholesterol and triglycerides, which can be a side effect of HIV treatment.
Not treating HIV may also be a risk factor. Generally, the benefits of HIV treatment far outweigh any additional risk of heart disease. However, people with higher risk of heart disease should choose their HIV drugs to minimise this risk.
The largest study looking at risks for heart disease and HIV treatment, reported an increased risk of heart disease related to use of protease inhibitor-based regimens, rather than using NNRTI-based combinations.
An assessment of cardiovascular and HIV risk factors is therefore recommended before starting HIV treatment.
As with the general population, making lifestyle changes to reduce risk of heart disease is good advice if you are HIV-positive. This becomes more important as the number of other risk factors increases.
Contents. Children. Age Early
and late diagnosis.
This is the web edition of the i-Base guide Introduction to
combination therapy. This guide is available in UK clinics.
Decisions relating to your treatment should always be taken in consultation with your doctor. Information in this guide is intended to support those discussions.
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