An Introduction To Anti Retro Viral Therapy

An Introduction to Antiretroviral Therapy
Drug Adherence - A Key to Treatment SUCCESS
Special Preventive Programme
Centre for Health Protection Department of Health

Content
Preface 3
The Human Immunodeficiency Virus (HIV) life cycle 4
What is antiretroviral therapy? 5
Effects of antiretroviral therapy 6
What kinds of antiretroviral therapy are available in Hong Kong? 7
When to consider using antiretroviral therapy? 9
Special attention while taking antiretroviral drugs 10
Nine tips on successful drug taking 11
How to control over antiretroviral therapy? 12
How to know whether treatment is working? 12
What is meant by "undetectable" viral load? 13
The importance of drug adherence 14
Degree of drug adherence 14
Non-adherence can lead to drug resistance 15
Signs of treatment failure 17
Side effects of antiretroviral therapy 18

Managing side effects 20
The use of antiretroviral agents for prophylaxis 26
Conclusion 27
Appendix
I.
Classes of antiretroviral drugs 28
II .
Progress sheet 38
III.
Useful telephone numbers and websites 40
PREFACE
The use of antiretroviral therapy can effectively control HIV
and its disease progress.
Successful treatment depends on how you know about and
get the most from your medicine over a long period of time.
Stay on your medication and work together
with your health care providers is a
smart way to reach the goal.
This booklet aims to promote your understanding

about how antiretroviral therapy can help you live a longer
and healthier life.
If you have further questions after reading this booklet,
please be sure to talk to your doctor and / or other health care
providers to obtain the feedback.
Drug Adherence - A key to treatment success 3

1
The Human Immunodeficiency Virus (HIV) life cycle
HIV enters a healthy CD4 cell. Once inside the cell, HIV coverts its
own genetic material RNA into DNA using the enzyme reverse
transcriptase. This new DNA acts as a blueprint directing the infected
cell to make new virus particles. Mature viral cores are produced
through action of viral protease after budding. The new virus is then
released and can infect other healthy cells. Thus, the function of
immune system will be progressively destroyed.
Human DNA
HIV DNA HIV DNA
HIV RNA
4
2
What is antiretroviral therapy (ART) ?
The antiretroviral agents attack HIV at different stages of its life cycle
to inhibit HIV replication and thus bring the viral load down.
Combination therapy of two or more drug components has become
the standard of treatment of HIV disease.
"Cocktail" is a colloquial term for HIV combination therapy.
Highly active anti-retroviral therapy (HAART)

HAART refers to very potent regimen in which almost invariably
inhibits viral replication to an undetectable level in the blood. An
example of HAART is the use of triple therapy comprises 2
Nucleoside Reverse Transcriptase Inhibitors (NRTI) and 1 Protease
Inhibitors (PI).

3
Effects of antiretroviral therapy
Restore health and defense function
Decline in AIDS morbidity, hospitalization and mortality
Improve well-being
Improve the quality of life
Prolong survival of the patients with AIDS
Goals of Therapy
Suppression of viral replication to an undetectable level is the goal of
HAART. Effectiveness of the treatment is readily demonstrable by a
precipitous fall in plasma viral load and often a rise in CD4 count.
6
4
What kinds of antiretroviral therapy are available in Hong Kong?
1
(I) (NRTI)
There are three classes of antiretroviral drugs available in Hong Kong

(Appendix I):
(I) Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI)

Action: HIV's enzyme called reverse transcriptase convert RNA to
DNA. NRTI block reverse transcription by providing faulty
building blocks that interrupt the process.
Currently available drugs in this class are:
1. Zidovudine (AZT) (Retrovir)

2. Didanosine (ddI) (Videx)
3. Didanosine EC (ddIEC) (Videx EC)
4. Lamivudine (3TC) (Epivir)
5. Zalcitabine (ddC) (Hivid)
6. Stavudine (d4T) (Zerit)
7. Combivir (CBV)
8. Abacavir (ABC) (Ziagen)
9. Tenofovir (TDF) (Viread)
10. Trizivir (ABC+AZT+3TC)

2
(II) (NNRTI)
(II) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)

Action: NNRTI stop HIV production by binding directly onto reverse
transcriptase and prevent the enzyme from converting RNA
to DNA.
3
1. Efavirenz (EFZ) (Sustiva)
2. Nevirapine (NVP) (Viramune)
(III) (PI)
(III) Protease Inhibitors (PI)

Action : PI block the action of an enzyme, called Protease that cuts
HIV protein chains into specific proteins needed to assemble
a new copy of HIV. Therefore, PI prevent the cell from
producing new HIV.
1. Indinavir (IDV) (Crixivan)

2. Saquinavir (SQV) (Hard gel-Invirase, Soft gel-Fortovase)
3. Ritonavir (RTV) (Norvir)
4. Nelfinavir (NFV) (Viracept)
5. Kaletra (LPV+RTV)
8
5
When to consider using antiretroviral therapy?
The doctor will consider using antiretroviral therapy when the infected
individual has suffered clinically or immunologically from the virus or
has at a heightened risk of disease progression. The following are
the indicators for treatment:
Low CD4 count
High viral load level
Signs of opportunistic infection
Psychologically well prepared to comply with this long-term treatment
in order to achieve the goal of therapy
?
?? ? ???
?
? ?
6
Special attention while taking antiretroviral drugs
Different drugs would have different precautions, e.g.:
Some drugs work best when they are taken with food while some
should be taken on an empty stomach.
May need to increase water intake.
Some kinds of food, drugs, Chinese medicines or alcohol should be
avoided to prevent adverse reaction.
Some drugs need to be stored in a refrigerator or special container.
Thus, the infected individual should follow the instruction of

health care providers when taking antiretroviral drugs.
10
7
Nine tips on successful drug taking
Commit to drug taking strongly
Fit the drug regimen into your daily activities
Keep drugs in the places you usually go
Know well your drug regimen in terms of the right dosage,

frequency and ways of drug taking
Bring along a bottle of water for drug taking
Make use of an alarm clock, a pager or chart to remind yourself

the time of drug taking
Use a pill box to contain one-day medication to remind yourself

of the correct dosage
Seek help from health care providers to work out a drug schedule
that suit you most
Seek support from significant others
o u c a n d o this !
y
8
How to control over antiretroviral therapy?
Make a personal commitment to your therapy
Keep in close touch with your health care providers
Attend regular follow-up
9
How to know whether treatment is working?
Health monitoring blood test:

CD4 count reflect how strong immune system is
Viral load measurement measure level of HIV in blood
In general, treatment is considered to be working

if the viral load is falling or remains low, and the
CD4 count level is rising or remains stable.
12
10
What is meant by "undetectable" viral load?
Undetectable viral load means that HIV level is too low to be picked
up by the viral load test. HIV are still in the body and can transmit to
others through sexual and blood contact. Therefore, it is essential to
continue treatment and take precautions against its spread e.g.
safer sex.

11
The importance of drug adherence
The most important element in the success of your anti-HIV treatment

is to strictly adhere to the drug regimen. Good drug adherence can
prevent treatment failure and the emergence of resistance. Poor drug
adherence will lead to the development of drug resistance, limiting the
effectiveness of therapy.
Thus, the most important thing you can do to stay healthy is always to
take your drugs in the right way and at the right time.
12
Degree of drug adherence
The nurse counsellor usually calculates your degree of drug

adherence by:
No. of doses No. of prescribed 100%

of ART taken doses of ART
14
13
Non-adherence can lead to drug resistance
Drug resistance means the reduction of a drug's ability to work

against HIV. Resistance is thought to occur when its target mutates,
changing its structure so that the drug can no longer bind to work as
well as it used to.
Missing doses or taking even short "drug holidays" give the virus
change its form and multiply. When you start taking your drugs
again, they may not work as well. Thus, non-adherence to drug
regimen can lead to drug resistance.
Cross-resistance:
The mechanism by which HIV that has developed resistance to one
drug may also be resistant to other similar drugs.

DRUG RESISTANCE
Taking drugs regularly helps you control the virus:

Drug concentration
Virus replication is
inhibited, mutation is
unlikely to occur.
Level that inhibits

viral replication
Taking your drugs on time, every time is essential and has its reward:
Lower or undetectable viral load result
higher CD4 count, increase/maintain immune function.
Non-adherence enables the virus to gain control again:

Drug concentration
Virus will replicate!
Mutations are more frequent

during active replication.
Some mutated virus are
resistant to drugs.
Missed dose!!
TREATMENT FAILURE
The best way to avoid resistance is to adhere to the regimen-

EVERYDAY, EVERY TIME
16
14
Signs of treatment failure
Increase viral load

Decrease CD4 count
Increase risk of disease progression
Increase hospitalization and risk of death
Missing doses or taking the wrong doses can lead to drug

resistance. You can quickly become resistant to
antiretroviral drugs if you do not take them at the right time,
in the right way and in the right dose. If drug failure is
evident in terms of clinical, immunological, or virological
deterioration, change of antiretroviral regimen is indicated.

15
18
15 Side effects of antiretroviral therapy
Many side effects are temporary. If you encounter unpleasant side
effects, do not discontinue the drugs or alter the dosage by yourself.
You should discuss your problem with the health care providers to
understand the alternatives of the way and time of drug taking, so that
a more appropriate drug taking plan could be developed.
Transient side effects:

Nausea/ vomiting
Diarrhoea
Allergy
Headache
Fatigue
Fever
Central Nervous System (CNS) symptoms
(e.g. dizziness, insomnia, drowsiness, nightmares, inability to
concentrate, etc.)
Potential long term side effects:

Anaemia (low red blood cell count)
Kidney stones
Deranged liver function
Peripheral neuropathy
Pancreatitis
Redistribution of fat (lipodystrophy)
Metabolic problems
(e.g. increase blood fats/ blood sugar)
Neutropenia (an abnormal decrease in the number of neutrophils
in the blood)

16
20
16 Managing side effects
Side effects to antiretroviral drugs are common during the first few weeks
of treatment. However, these symptoms will often pass as your body gets
used to the drugs. You should report any unusual symptoms to your
doctor/health care providers. If necessary, your doctor will prescribe
medications to help you get over the initial period. The following is a
quick reference for managing side effects of antiretroviral drugs.
Managing side effects: A quick reference chart

Diarrhoea
Self management:
Eat white rice, toast, oatmeal, apple sauce, or bananas
Avoid spicy foods, fatty foods, and foods that promote gas,
e.g. peanuts, onion
Avoid high fibre food, such as brown rice or whole grain bread
Drink a lot of liquid to replace fluids lost
Consult your doctor:
Check for signs of infections
Prescribe medications for diarrhoea
Upset Stomach (Nausea, Vomiting, Poor Appetite)

Self management:
Eat dry foods like crackers, toast, and dry cereal
Sip clear liquids like ginger ale or juice mixed with water
Eat foods that appeal to you even when you are not hungry
Eat small and frequent meals
Avoid eating very sweet , spicy or fatty food
Avoid lying down directly after a meal
Avoid drinking fluids immediately before, with or after meals
Prescribe medications for upset stomach
Prescribe medications to improve your appetite
Clarify with your doctor about your drug taking pattern and the
suitable timing of meals to avoid gastric upset

22
Feeling Tired (Fatigue)
Self management:
Take a balance diet and exercise regularly
Get adequate rest
Ask for help with work so as to save energy for important tasks
Check for signs of anaemia
Dizziness, Confusion, and Sleeping Problems

Self management:
Take medications at the best time of day to reduce side effects,
e.g. Efavirenz is best taken at bedtime
Stay in bed if possible
Consider other causes, leading to the side effect e.g. depression
Enquire about the change of drugs or time of drug taking
Prescribe medications for discomfort
Headache
Self management:
Take adequate rest
Do relaxation exercise
Listen to light music
Prescribe medications for headache
Fat Problems (Lipodystrophy)

Self management:
Get regular exercise and eat a healthy diet. This may not reduce
lipodystrophy, but it will keep your weight and overall body fat at
a healthier level
Enquire about experimental treatments to be used for repairing
facial fat changes

24
Nerve Problems, Tingling Hands and Feet (Neuropathy)
Self management:
Avoid walking or standing for a long period of time
Soak your feet in cool water
Massage hands and feet
Avoid wearing tight socks or shoes
Enquire the possibility of change of drugs
Refer to see a neurologist
Prescribe medications for neuropathy
Liver Problems
Self management:
Quit or reduce alcohol drinking
Monitor liver enzyme blood tests regularly
Enquire about changing of drugs or alternative therapy
Metabolic Problems
Self management:
Exercise on a regular basis if possible
Quit or reduce smoking
Monitor cholesterol, triglycerides, and glucose tests (the blood
tests that measure fats and sugar in your blood) regularly
Bone Problems
Self management:
Get enough calcium and vitamin D from food, such as fortified
soy, rice milk
Do weight-bearing exercise like walking or weight lifting
Prescribe medications for discomfort

17
The use of antiretroviral agents for prophylaxis
Effectiveness of antiretroviral drugs is already well-proven as

prophylaxis to reduce the risk of HIV transmission in two specific
health care settings:
Perinatal infection (mother to child transmission)

Post occupational exposure prophylaxis
26
18
Conclusion
By using antiretroviral therapy and adopting good drug adherence

practice, you can stay a healthy life. Be relax, take nutritious food,
do regular exercise, join a support group and develop a hobby are
some smart ways to maintain good health and improve your quality
of life.
qua lity of life

I
(NRTI)
1 Zidovudine
(AZT)
Retrovir
2 Didanosine
(ddI)
Videx
3 Didanosine
EC
(ddIEC)
Videx EC
4 Lamivudine
(3TC)
Epivir
28
APPENDIX
I Classes of antiretroviral drugs

(A)Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI)
Drug
Drug Dosage Potential side effects Remarks
1 Zidovudine 200mg Anaemia If nausea, take after

(AZT) 3 times/day Neutropenia meal
Retrovir or G I intolerance
100mg/cap 300mg Headache
2 times/day Insomnia
Asthenia
Lactic acidosis with hepatic
steatosis (rare): fatigue,
severe vomiting, dyspnoea
2 Didanosine 125mg or Peripheral neuropathy Chewed/crushed/

(ddI) 200mg Pancreatitis dissolved
Videx 2 times/day Nausea Take on empty
25mg/tab Diarrhoea stomach
100mg/tab Lactic acidosis with hepatic Take with IDV at
steatosis (rare): fatigue, least 1 hr apart
3 Didanosine 250mg or Peripheral neuropathy Take on empty

EC 400mg Pancreatitis stomach
(ddIEC) daily Nausea Take with IDV at
Videx EC Diarrhoea least 1 hr apart
250mg/tab Lactic acidosis with hepatic Take with meal if take
400mg/tab steatosis (rare): fatigue, TDF together
4 Lamivudine 150mg Minimal toxicity Rapid emergence of

(3TC) 2 times/day Lactic acidosis with resistant strains if
Epivir hepatic steatosis (rare): non-adherent
150mg/tab fatigue, severe vomiting,
dyspnoea

5 Zalcitabine
(ddC)
Hivid
6 Stavudine
(d4T)
Zerit
7 Combivir
(CBV)
8 Abacavir
(ABC)
Ziagen
30
APPENDIX
5 Zalcitabine 0.75 mg Peripheral neuropathy

(ddC) 3 times/day Stomatitis
Hivid Pancreatitis
0.75mg/tab Lactic acidosis with hepatic
6 Stavudine 30mg or Peripheral neuropathy

(d4T) 40mg Lipodystrophy
Zerit 2 times/day Lactic acidosis with hepatic
30mg/cap steatosis (rare): fatigue,
40mg/cap severe vomiting, dyspnoea
Pancreatitis
Rapidly progressive ascending
neuromuscular weakness
(rare)
7 Combivir 1 tab Anaemia

(CBV) 2 times/day Neutropenia
=150mg Headache
3TC + G I intolerance
300mg Insomnia
AZT/tab Asthenia
8 Abacavir 300mg Hypersensitivity reaction If there is fever, rash,

(ABC) 2 times/day (5% of people) symptoms report to health care
Ziagen may include fever, rash, workers at once
300mg/tab nausea, vomiting, malaise,
fatigue or loss of appetite,
respiratory symptoms such
as sore throat, cough,
shortness of breath

9 Tenofovir
(TDF)
Viread
10 Trizivir
(ABC +
AZT + 3TC)
(NNRTI)
1 Efavirenz
(EFZ)
Stocrin,
Sustiva
32
APPENDIX
Drug
9 Tenofovir 300mg daily Asthenia Take with meal

(TDF) Headache Dosage adjustment
Viread G I intolerance in renal insufficiency
300mg/tab Flatulence
Rare report of renal
insufficiency
10 Trizivir 1 tab Anaemia If there is any flu like

(ABC + 2 times/day Neutropenia symptom fever, rash,
AZT + 3TC) G I intolerance report to health care
Headache workers at once
Insomnia
Asthenia
steatosis: fatigue, severe
vomiting, dyspnoea
Hypersensitivity reaction
(B)Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)

1 Efavirenz 600mg daily Rash Decrease CNS

(EFZ) (preferably CNS symptoms: symptoms if take at
Stocrin, at bed time) dizziness, somnolence, bed time
Sustiva insomnia, drowsiness, Pregnancy is
200mg/cap nightmares, hallucinations, contraindicated
600mg/tab poor concentration (usually
subside in 2-4 weeks if really
appear)
Increased transaminase levels

2 Nevirapine
(NVP)
Viramune
(PI)
1 Indinavir
(IDV)
Crixivan
2 Saquinavir
(SQV)
Invirase
( )
Fortovase
( )
34
APPENDIX
Drug
2 Nevirapine 200mg daily Rash Anti-TB drugs and

(NVP) for 2 weeks, Symptomatic hepatitis oral contraceptive
Viramune then 200mg pills should be used
200mg/tab 2 times/day with caution
Rapid emergence
of resistant strains
if non-adherent
(C)Protease Inhibitors (PI)

1 Indinavir 800mg Q8h Nephrolithiasis Take with empty

(IDV) 3 times/day G I intolerance stomach
Crixivan Increased indirect bilirubinemia Drink water 1.5
200mg/cap Misc.: headache, asthenia, litre/day
400mg/cap blurred vision, dizziness, rash, Avoid grapefruit juice
metallic taste,
thrombocytopenia, alopecia,
and hemolytic anaemia
Fat redistribution
Lipid abnormalities
Hyperglycemia
2 Saquinavir Invirase Headache Take after meal,

(SQV) 600mg G I intolerance preferably fatty to
Invirase 3 times/day Elevated transaminase increase absorption
(hard gel) Fortovase enzymes Rifampicin &
200mg/cap 1200mg Hyperglycemia Rifabutin are
Fortovase 3 times/day Fat redistribution contraindicated with
(soft gel) Lipid abnormalities SQV
200mg/cap Possible increased bleeding Fortovase (soft gel)
episodes in patients with should be refrigerated
hemophilia or stored at room
temperature 25 C
(up to 3 months)

3 Ritonavir
(RTV)
Norvir
4 Nelfinavir
(NFV)
Viracept
5 Kaletra
= Lopinavir
(LPV)
133.3mg +
Ritonavir
(RTV)
Reference:
Department of Health, Guidelines for the Use of Antiretroviral Agents in HIV-I-Infected Adults and
Adolescents. convened by DHHS. March, 2004. P.59-64
36
APPENDIX
3 Ritonavir 600mg Headache Capsules should be

(RTV) 2 times/day G I intolerance refrigerated. If stored
Norvir Paresthesias - circumoral and at room temperature
100mg/cap extremities 25 C, it is stable
syrup Hepatitis for 30 days
80mg/ml Pancreatitis Take after meal to
Asthenia improve tolerance
Taste perversion Need dosage
Lab.: Triglycerides increase adjustment if take
>200%, transaminase with SQV
elevation, elevated CPK and Avoid self-prescribe
uric acid drugs because of
Hyperglycemia drug interaction
Fat redistribution
Lipid abnormalities
Possible increased bleeding
episodes in patients with
hemophilia
4 Nelfinavir 750mg Diarrhoea Take with meal

(NFV) 3 times/day Hyperglycemia
Viracept or Fat redistribution
250mg/tab 1250mg Lipid abnormalities
2 times/day Serum transaminase elevation
Possible increased bleeding
episodes in patients with
hemophilia
5 Kaletra 3 capsules Diarrhoea Take with meal
= Lopinavir 2 times/day G I intolerance Use additional type of
(LPV) Asthenia contraception since
133.3mg + Elevated serum transaminases Kaletra may reduce
Ritonavir Hyperglycemia the effectiveness of
(RTV) Fat redistribution oral contraceptives
33.3mg/cap Lipid abnormalities Should be refrigerated.
Possible increased bleeding If stored at room
episodes in patients with temperature 25 C, it
hemophilia is stable for 2 months

II
38
APPENDIX
II Progress Sheet
Date CD4 Count Viral Load Remarks

III
40
APPENDIX
III Useful telephone numbers and websites:

Government Organizations:
Kowloon Bay Integrated Treatment Centre
Tel: 2117 0333
Red Ribbon Centre
Tel: 2304 6268 http://www.rrc-hk.com
AIDS Hotline
Tel: 2780 2211 http://www.27802211.com
Harm Reduction Hotline
Tel: 2112 9977 http://www.harmreduction-hk.com
AIDS Non-governmental Organizations & Drug related Organizations:

Hong Kong AIDS Foundation
Tel: 2560 8528
Hotline: 2513 0513 http://www.aids.org.hk
AIDS Concern Hotline
Tel: 2898 4422 http://www.aidsconcern.org.hk
The Society for AIDS Care
Tel: 2559 2006 http://www.aidscare.com.hk/cindex.htm
Teen AIDS
Tel: 2554 3399 http://www.teenaids.org.hk
The Society for the AIDS and Rehabilitation of Drug Abusers (SARDA) Hotline
Tel: 2574 3300
Overseas Internet / Website for more information about HIV Treatment:

http://www.aidsmap.com
http://www.hivatis.org
http://www.hivresources.com
http://www.iasusa.org
http://www.medscape.com
http://www.treathiv.com
http://www.unaids.org

11 / 2004
Production of Integrated Treatment Centre
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An Introduction to Antiretroviral Therapy

Drug Adherence - A Key to Treatment SUCCESS

Special Preventive Programme

Centre for Health Protection Department of Health

The Human Immunodeficiency Virus (HIV) life cycle 4

What is antiretroviral therapy? 5

Effects of antiretroviral therapy 6

What kinds of antiretroviral therapy are available in Hong Kong? 7

When to consider using antiretroviral therapy? 9

Special attention while taking antiretroviral drugs 10

Nine tips on successful drug taking 11

How to control over antiretroviral therapy? 12

How to know whether treatment is working? 12

What is meant by "undetectable" viral load? 13

The importance of drug adherence 14

Degree of drug adherence 14

Non-adherence can lead to drug resistance 15

Signs of treatment failure 17

Side effects of antiretroviral therapy 18

The use of antiretroviral agents for prophylaxis 26

This booklet aims to promote your understanding

Drug Adherence - A key to treatment success 3

HIV DNA HIV DNA

"Cocktail" is a colloquial term for HIV combination therapy.

Highly active anti-retroviral therapy (HAART)

Drug Adherence - A key to treatment success 5

Restore health and defense function

Decline in AIDS morbidity, hospitalization and mortality

Improve the quality of life

Prolong survival of the patients with AIDS

There are three classes of antiretroviral drugs available in Hong Kong

(I) Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI)

Currently available drugs in this class are:

1. Zidovudine (AZT) (Retrovir)

Drug Adherence - A key to treatment success 7

(II) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)

Currently available drugs in this class are:

(III) Protease Inhibitors (PI)

Currently available drugs in this class are:

1. Indinavir (IDV) (Crixivan)

Different drugs would have different precautions, e.g.:

Thus, the infected individual should follow the instruction of

Commit to drug taking strongly

Fit the drug regimen into your daily activities

Keep drugs in the places you usually go

Know well your drug regimen in terms of the right dosage,

Bring along a bottle of water for drug taking

Make use of an alarm clock, a pager or chart to remind yourself

Use a pill box to contain one-day medication to remind yourself

Seek support from significant others

Make a personal commitment to your therapy

Keep in close touch with your health care providers

Attend regular follow-up

Health monitoring blood test:

In general, treatment is considered to be working

Drug Adherence - A key to treatment success 13

The most important element in the success of your anti-HIV treatment

The nurse counsellor usually calculates your degree of drug

No. of doses No. of prescribed 100%

Drug resistance means the reduction of a drug's ability to work

Drug Adherence - A key to treatment success 15

Taking drugs regularly helps you control the virus:

Level that inhibits