Considering HIV Treatment

Table of Contents

• Preparing for HIV Treatment
• Starting Sooner Rather Than Later
• The Right Health Care Provider
• Knowledge About HIV
• A Positive Attitude

Preparing for HIV Treatment

Are you living with HIV (HIV+)? If so, treatment with HIV drugs can improve your quality of life and help you stay healthier longer. But starting treatment is a big decision. In order to get the most benefit from HIV drugs, they must be used just the way they are prescribed. Taking your treatment correctly is as important as which drugs you and your health care provider choose. So before you get started, it is important to be prepared and commit to taking your HIV drugs the right way, every day for your own health. This takes a combination of the right health care provider, enough knowledge about HIV, and a positive attitude.

Starting Sooner Rather Than Later

The results of a recent study (the START trial) have definitively shown that people living with HIV who start treatment earlier, while their CD4 counts are still high, have a much lower risk of illness and death. This includes people living with HIV who may have no outward signs of ill health. The study showed that taking HIV drugs earlier reduced the likelihood of developing not only AIDS-related illnesses, but also non-AIDS related illnesses.

Benefits of Starting Early

• Having a higher CD4 cell count and keeping it high
• Preventing further damage to the immune system
• Decreasing risk for HIV-related and non-HIV-related health problems
• Reducing your risk of spreading HIV to others (also known as Treatment as Prevention), including sexual partners and babies (through perinatal transmission, or mother-to-child transmission)

Risks of Starting Late

• Having a severely weakened immune system. This can mean that it takes longer to restore your immune system to full strength and you to full health. Recent studies have shown that delaying treatment can increase the chances that people living with HIV will develop AIDS and other serious illnesses.
• Having an increased chance of immune reconstitution syndrome when you begin taking HIV drugs
• Spreading HIV to others, including sexual partners and babies (if you become pregnant)

Over the past several years, experts have debated the potential benefits and risks of starting HIV treatment while people are relatively healthy (have high CD4 counts and no signs of ill health). With the results of the START trial, it appears clear that the benefits of starting treatment early outweigh any potential risks. Consequently, scientific experts and policy makers came together in July 2015 and issued a consensus statement declaring that all people living with HIV should have access to HIV treatment as soon as they are diagnosed. This statement was supported by agencies such as the International AIDS Society, the US President's Emergency Plan for AIDS Relief (PEPFAR), and UNAIDS, among others.

Treatment Guidelines

Guidelines for HIV treatment are issued by a variety of global and country-based agencies. They provide a lot of useful information to help health care providers and people living with HIV make decisions about when to start, when to stop, and when to change HIV medications. They also help providers and people living with HIV choose among the many available HIV drugs. Guidelines are written and reviewed regularly by groups of HIV experts, including researchers, healthcare providers, and community activists.

The US Department of Health and Human Services (DHHS) HIV treatment guidelines recommend that all people living with HIV take HIV drugs, no matter what their CD4 count.

Based in part on the results of the START trial, the World Health Organization (WHO) is expected to issue new HIV treatment guidelines late in 2015 that recommend HIV treatment for all people living with HIV, regardless of their CD4 count.

The British HIV Association (BHIVA)'s treatment guidelines, last updated in June 2014, recommend that all people living with HIV who have CD4 counts less than 350 be treated with a combination of HIV drugs. New BHIVA guidelines will take into account the results of the START trial. The BHIVA's current guidelines also mention several situations in which treatment should begin for people with CD4 counts above 350. This includes instances in which people with CD4 counts greater than 350 wish to start HIV drugs. The BHIVA recommends that these people have their wishes respected and begin treatment. Similarly, the BHIVA recommends that all pregnant women receive HIV treatment, regardless of their CD4 counts.

Starting sooner rather than later is a decision for you to make with your provider, who will look at a variety of factors, including some baseline blood tests and readiness to start and stick to lifelong treatment (see below).

The Right Health Care Provider

In an ideal world, you and your health care provider are a team working together to make the best treatment decisions for you. You may want to ask yourself a few questions about your relationship with your health care provider: Do I have confidence in my provider? Can I be totally honest with him or her? Is she or he available when I have questions? Does he or she take my concerns seriously? If so, great!

If not, you may want to make some changes. Although it can be difficult, you may want to ask your provider directly if she or he will be available for questions. If you do not feel fully respected or taken seriously, you may consider telling your provider that you are concerned that your relationship is not as strong as it could be because of how you feel. It may help to write down the questions you would like to ask your health care provider before you go to visits. Finally, it is always important to answer your provider's questions with the truth, not with what you think she or he wants to hear. If these steps still do not work, it may be time to look for another provider.

It is also wise to have a health care provider who is an HIV specialist. Health care providers who devote most of their time to HIV are best able to manage this condition. Helpful suggestions for HIV specialists near you can come from friends and/or ASOs (AIDS Service Organizations), or by checking with the American Academy of HIV Medicine (AAHIVM). To find an ASO in your area, click here or look at the AAHIVM's Referral Link. For services worldwide, please use AIDSmap's e-atlas.