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Considering HIV Treatment

August 17, 2015

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Knowledge About HIV

The Basics

HIV is a virus that destroys CD4 cells. CD4 cells are part of the body's immune system. The immune system protects the body from germs such as bacteria, fungi, and other viruses. When the immune system loses too many CD4 cells, it becomes weak and is unable to fight off germs, leading to opportunistic infections (OIs) that can cause serious illness or death.

HIV Treatments

Scientists have developed drugs that stop HIV from making copies of itself (multiplying). These drugs are grouped into classes. Each class of drugs works to stop HIV at a certain point in its life cycle. There are six classes of drugs:

  • Entry inhibitors (including 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

HIV drugs are always used in combination to attack the virus at different points in its life cycle. This usually means using drugs from at least two different classes. Combining HIV drugs is the best way to reduce the amount of HIV in your blood (viral load).


Baseline Blood Tests

Before you start HIV treatment, your health care provider should have you take a number of blood tests. These are your original, or baseline tests. Future test results will be compared to your original or baseline results to see how you are doing and how well your treatment is working.

  1. CD4 cell (T-cell) count: The CD4 count checks the strength of your immune system. After you start HIV treatment, you should see your CD4 count go up. Your CD4 count should be checked every three to four months, if possible, then every six months to one year, once it has become stable.
  2. Viral load test: The viral load test measures the amount of HIV in your blood. After you start HIV treatment, you should see your viral load go down. Your viral load should be checked about a month after you start or change HIV drugs. After that, it should be checked every three to four months, then every six months, once it has become undetectable in your bloodstream and stays undetectable.
  3. Resistance test: The resistance test helps determine which drugs are likely to work against the strain of HIV you have. Experts recommend that everyone get a resistance test before starting or changing HIV treatments, even if you do not plan to start HIV treatment for a while.
  4. Other tests to check your overall health: These include complete blood count (CBC), chemistry screen, lipid profile (cholesterol and fat), liver tests, and glucose (blood sugar). Your health care provider should talk with you about how often these tests need to be done.

Treatment Goals

  • To get your viral load as low as possible for as long as possible
  • To preserve or improve the health of your immune system by increasing your CD4 cells
  • To improve your quality of life and reduce illness
  • To reduce your risk of spreading HIV to others


Whenever you start treatment, you need to take your drugs on schedule and exactly as prescribed. This is called adherence. In order to get the best benefit from HIV therapy, good adherence is required. This is because HIV drugs need to be kept at a certain level in your body to fight the virus. If the drug level falls, HIV may have a chance to fight back. Skipping doses, not taking the drugs on time, and not following food requirements can all cause your drugs to be less effective or to stop working altogether.


After starting HIV drugs, you should see your viral load decrease and your CD4 cells increase. Over time, however, some people see their viral load increase, even though they are still taking HIV drugs.

When a drug is no longer able to fight HIV effectively, HIV has become "resistant" to that drug. If you develop resistance, you will likely have to change some of the drugs in your regimen. If your viral load goes up while you are still taking your HIV drug regimen, your health care provider should offer you a resistance test to find out which drugs are not working and to help choose ones that will. For some people with resistance to many HIV drugs, it may be difficult to find a new combination.

The best way to fight resistance is to be adherent to your drug regimen.

A Positive Attitude

When considering starting treatment, it is important to have a good attitude. It can be helpful to believe that:

  • starting treatment is the right decision for you
  • the HIV drugs will help you fight the virus
  • you can take your medications the right way

It may also help to get in touch with the reason you are starting treatment -- to keep yourself in good health, whether for your own sake or for the good of your family. Think about it this way: when you have a cold and need antibiotics, your provider does not wait until you have pneumonia before giving you the antibiotics. The same is true for being infected with HIV. You need not wait until your immune system is damaged before taking HIV drugs. Newer HIV drugs are much better tolerated and have fewer side effects.

When you consider starting treatment, it is also important not to go it alone. Put together a support system that may include your health care provider, social workers, case managers, family, or friends. You may also consider joining a support group of other people living with HIV.

Whatever you decide to do, it is important that you keep going to your health care provider for regular check ups and remain focused on staying healthy.

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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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