When to Start Anti-HIV Medications

I just tested HIV positive. Do I need to start treatment?

Even though you have HIV, you may not need to start treatment right away. When to start anti-HIV medications (also called antiretrovirals) depends on several factors, including:

• Your overall health
• How well your immune system is working (CD4 count)
• The amount of HIV in your blood (viral load)
• Whether you're pregnant
• Your ability and willingness to commit to lifelong treatment

You and your health care provider will work together to decide on the best time to start treatment.

Can anti-HIV medications really help?

Yes! Although anti-HIV medications can't cure HIV, treatment can keep you healthy and improve your quality of life.

HIV attacks the immune system, destroying the system's CD4 cells. This makes it hard for the body to fight infection. But anti-HIV medications can prevent HIV from multiplying. Reducing the amount of HIV in your body gives the immune system a chance to recover and produce more infection-fighting CD4 cells. An increase in CD4 count indicates that treatment is working.

Once you start treatment -- and take your anti-HIV medications exactly as directed -- it's possible to have an undetectable viral load within 3 to 6 months. An undetectable viral load means that the level of HIV in your blood is too low to be detected by a viral load test. You aren't cured. There is still some HIV in your body. However, an undetectable viral load indicates that your anti-HIV medications are working effectively to keep you healthy and reduce your risk of transmitting HIV.

How will I know when to start anti-HIV medications?

It's time to start treatment if:

• Your CD4 count is less than 500 cells/mm³
• You have AIDS
• You're pregnant
• You have HIV-related kidney disease
• You need treatment for hepatitis B virus (HBV)

Some research suggests that it may be helpful to start treatment early, when the CD4 count is greater than 500 cells/mm³. You and your health care provider may want to discuss the benefits and risks of starting treatment early.

If anti-HIV medications can help me stay healthy, why wait to start treatment?

Successful HIV treatment depends on a lifelong commitment to take anti-HIV medications exactly as directed (treatment adherence). If you and your health care provider feel you're not ready to closely follow an HIV regimen for the rest of your life, you may decide to delay treatment. Delaying treatment will give you and your health care provider time to address any issues that may make adherence difficult. (To learn more about treatment adherence, see the Treatment Adherence and Following an HIV Treatment Regimen fact sheets.)

What treatment is right for me?

The U.S. Department of Health and Human Services (HHS) provides guidelines on using anti-HIV medications to treat HIV infection. The HHS guidelines recommend starting treatment with a regimen of three or more anti-HIV medications from at least two different drug classes. (See the FDA-Approved Anti-HIV Medications fact sheet.) Using a combination of anti-HIV medications to treat HIV is called antiretroviral therapy (ART). The HHS guidelines list preferred ART regimens. (See the Recommended HIV Treatment Regimens fact sheet.) Because people's needs vary, the preferred regimens may not be right for everyone. You and your health care provider will consider your individual needs to select the most effective regimen for you.

For More Information

Contact an AIDSinfo health information specialist at 1–800–448–0440 or visit http://aidsinfo.nih.gov. See your health care provider for medical advice.

This information is based on the U.S. Department of Health and Human Services' Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (available at http://aidsinfo.nih.gov/Guidelines/).