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Starting HIV Treatment

August 17, 2015

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Starting HIV Treatment

First Things First

When you and your health care provider decide the time is right for you to start treatment, there are things you can do to set yourself up for success. The first step is to think positively. Having the right attitude will help you get the most out of your treatment. It may be helpful to focus on how:

  • Starting treatment is the right decision for your health. Recent studies have shown that people living with HIV (HIV+) who start treatment earlier, while their CD4 counts are still high, have a much lower risk of illness and death.
  • HIV drugs will help you fight the virus and prevent damage to your immune system
  • You can take your medications the right way

It takes a lot of commitment to stick to a treatment regimen (combination of HIV drugs). There is no need for you to go it alone. Your health care provider is an important support and so are other people such as nurses, social workers, therapists, and case managers. You may want to join a support group for people living with HIV or check out our online support community, A Girl Like Me. Family and friends can help, too.

It can be tough to stick with a treatment regimen if you need to work on other issues in your life. If you feel down a lot of the time and do not enjoy things that you used to enjoy, you may be depressed. If you are depressed or feeling low, it is important to talk with your provider and get the support you need. Also talk with your provider if you have issues with substance use or feeling safe in your home (see our article on Violence Against Women and HIV). Taking care of problems with depression, substance use, and personal safety can really help you take your HIV drugs regularly and be as healthy as possible.

It is important for you to tell your health care provider if you have other health problems, are taking any other drugs (including over-the-counter medications, vitamins or supplements, or street drugs), are using any alternative or complementary therapies, or are in any recovery programs. This is important information that may affect your HIV treatment options. In addition, discuss family planning with your health care provider since HIV drugs can interfere with some birth control methods, and pregnant women should not take certain HIV drugs.

Choosing an HIV Drug Regimen

The next step is for you and your health care provider to choose a drug regimen. Currently, there are over 30 drugs approved for HIV treatment. They are grouped into six classes:

  • Entry inhibitors (includes fusion inhibitors and CCR5 antagonists)
  • Integrase inhibitors
  • Nucleoside/nucleotide reverse transcriptase inhibitors ("nukes" or NRTIs)
  • Non-nucleoside reverse transcriptase inhibitors ("non-nukes" or NNRTIs)
  • Protease inhibitors (PIs)
  • Boosting agents

There are many ways to combine the drugs, but experts recommend that people who have never taken HIV drugs before start with one of the following combinations:

  • An integrase inhibitor plus 2 NRTIs or
  • A PI plus 2 NRTIs [in most cases the PI should be combined, or "boosted," with a small dose of a second PI called Norvir (ritonavir); this makes the first PI work better] or
  • An NNRTI plus 2 NRTIs

More information about which drugs to take can be found in the US government's treatment guidelines or the World Health Organization's guidelines.


With any HIV regimen, a major problem can be the development of resistance. When HIV makes copies of itself (reproduces), it can make changes, called mutations. Some mutations prevent certain HIV drugs from working. When this happens, HIV has become "resistant" to a particular HIV drug. Your viral load can increase quickly if resistance occurs, and you may have to switch drug regimens.

In addition, if you become resistant to one drug, you can become resistant to other drugs in the same class more easily. This is known as cross-resistance. The more drugs to which you are resistant, the fewer treatment choices you have.

Resistance Tests

Before starting HIV treatment, it is important that your health care provider do a resistance test to find out if you have drug-resistant HIV. This helps determine which drugs might work best for you. The US treatment guidelines recommend resistance tests for:

  • People who have just become infected with HIV, whether or not they are going to take HIV drugs right away
  • People who have never taken HIV drugs and are starting to receive medical care, whether or not they are going to take HIV drugs right away
  • People who have never been on HIV drugs and are planning to start
  • People who are on HIV drugs and see their viral load go up
  • People who have recently started HIV drugs and their viral load is not coming down enough
  • Pregnant women living with HIV whose viral load is not as low as it should be


One of the strategies in HIV treatment is to think ahead. We know that drugs may stop working because of resistance and cross-resistance. When you and your health care provider choose your first regimen, it is also important to think about which drugs could be used in future regimens if your original HIV drugs stop working. This process is called sequencing your treatment. It ensures that you will have other treatment options available if resistance develops.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.


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