When to Start Antiretroviral Therapy
February 13, 2018
When Is It Time to Start Taking HIV Medicine?
Treatment with HIV medicines (called antiretroviral therapy or ART for short) is recommended for everyone with HIV. ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.
The Department of Health and Human Services (HHS) guidelines on the use of HIV medicines in adults and adolescents recommend that people with HIV start ART as soon as possible. In people with HIV who have certain conditions, it's especially important to start ART right away.
What Conditions Increase the Urgency to Start ART?
The following conditions increase the urgency to start ART:
All pregnant women with HIV should take HIV medicines to prevent mother-to-child transmission of HIV. The HIV medicines will also protect the health of the pregnant woman.
All pregnant women with HIV should start taking HIV medicines as soon as possible during pregnancy. In general, women who are already taking HIV medicines when they become pregnant should continue taking HIV medicines throughout their pregnancies. When HIV infection is diagnosed during pregnancy, ART should be started right away.
Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of HIV infection. People with AIDS should start ART immediately.
A diagnosis of AIDS is based on the following criteria:
HIV-Related Illnesses and Coinfections
Some illnesses that develop in people with HIV increase the urgency to start ART. These illnesses include HIV-related kidney disease and certain opportunistic infections (OIs). OIs are infections that develop more often or are more severe in people with weakened immune systems, such as people with HIV.
Coinfection is when a person has two or more infections at the same time. Coinfection with HIV and certain other infections, such as hepatitis B or hepatitis C virus infection, increases the urgency to start ART.
Early HIV infection
Recent HIV infection is the period up to 6 months after infection with HIV. During recent HIV infection, the level of HIV in the body (called viral load) is very high. A high viral load damages the immune system and increases the risk of HIV transmission.
ART is an important part of staying healthy with HIV. Studies suggest that these benefits begin even when ART is started in recent HIV infection. In addition, starting ART during recent HIV infection reduces the risk of HIV transmission.
Once a Person Starts ART, Why Is Medication Adherence Important?
Before starting ART, people with HIV discuss the benefits and risks of ART with their health care providers. They also discuss the importance of medication adherence -- taking HIV medicines every day and exactly as prescribed. Adherence to an HIV regimen prevents HIV from multiplying and destroying the immune system. Taking HIV medicines every day also reduces the risk of HIV transmission.
Before starting ART, it's important to address issues that can make adherence difficult. For example, a busy schedule or lack of health insurance to cover the cost of HIV medicines can make it hard to take HIV medicines consistently. Health care providers can recommend resources to help people deal with any issues that may interfere with adherence.
Read the following AIDSinfo fact sheets to learn more about medication adherence:
This fact sheet is based on information from the following sources:
From the U.S. Department of Health and Human Services:
[Note from TheBody: This article was created by AIDSinfo, who last updated it on Jan. 24, 2018. We have cross-posted it with their permission.]
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