Has your viral load trend:
30,000 or Below (Generally Considered Low)Therapy is generally not recommended, but if you're experiencing symptoms or have very low CD4+ cell counts, considering therapy might still be warranted.
30,000-50,000Federal guidelines suggest considering therapy if your CD4+ count is also below 350. However, if your CD4+ cell count is high (above 350), it's reasonable to wait.
Viral load readings, especially in the first 3-5 years after infection with HIV, may be different in women and men. While viral load readings of 30,000-50,000 are generally considered moderate/low in men, this might be high for a woman and signal a more pressing need for intervention.
100,000 or Above (Considered High)Increased risk of disease progression. Federal guidelines strongly suggest and encourage anti-HIV therapy.
Over your last few tests, has your CD4+ cell count trend:
Is your CD4+ count generally declining or is it mostly stable, with just modest movement (100 points or less) up and down? A stable CD4+ count, as long as it is above 200, has less risk of progression than one that is steadily declining.
Therapy is generally not recommended. If your viral load is high and/or you're experiencing symptoms, therapy might still be warranted. However, if the CD4+ count is declining rapidly and consistently, and the viral load is high, some doctors might recommend treatment or more frequent monitoring.
Guidelines suggest considering therapy when CD4+ cell count is consistently at or below 350.
If your CD4+ cell counts are above 200, and you experience recurrent fungal infections (thrush, etc.), preventive therapy for Pneumocystis carinii pneumonia (PCP) is recommended.
If you choose not to use antivirals at this point, talk with your provider about preventive therapies against common infections, like Mycobacterium avium complex (MAC), cytomegalovirus (CMV) and toxoplasmosis. Monitor your lab values, weight, minor symptoms and overall sense of well-being.
If your CD4+ cell count and/or viral load levels change drastically from one test to another, discuss this with your provider. Large sudden changes are often the result of lab errors or other health factors (like a flu shot or stress).
For more information, read Project Inform's "Blood Work: A Useful Tool for Monitoring HIV."
Take time to talk with your doctor about his/her opinions and experiences with treatment and other people who you trust and have an understanding of therapy.
For more information, read Project Inform's "Anti-HIV Therapy Strategies."
|If you come to the decision that you want to start therapy, here are 4 other points to consider before starting and as you develop your strategy.|
Take a moment to reflect upon the various factors that can make taking your medications correctly challenging. Discuss this with your provider as you develop a treatment strategy. In addition, use those sources of support which will motivate you to stay adherent.
Some anti-HIV therapies, especially protease inhibitors and non-nucleoside reverse transcriptase inhibitors, can increase liver enzymes and/or cause hepatitis. Liver enzyme levels should be carefully monitored soon after starting anti-HIV therapy.
Are you taking treatment for HCV?
A 1-2 month gap is suggested between starting HIV and HCV treatment.
Treating HIV or HCV first will depend on the stage of liver disease and your CD4+ cell count and/or (HIV) viral load.
For more information, read Project Inform's "Hepatitis C."
There are known drug interactions between a variety of drugs, and even herb-drug interactions. These can worsen side effects and/or cause one or both therapies to be less effective. For example, some protease inhibitors can decrease the level of ethinyl-estradiol (chemical in oral contraceptives), making them less effective.
If you decide to take therapy, take all the medications, vitamins, supplements and/or alternative therapies that you're taking to your next doctor's appointment. Whenever you add or change a therapy or supplement, be sure to talk with all your health practitioners (and pharmacist) to make sure these products may be taken together safely.
For more information, read Project Inform's "Drug Interactions."
YesIf you have an active OI, talk to your physician about treating that OI before you start anti-HIV therapy.
NoIf you have had a major OI, aggressive anti-HIV therapy is almost always recommended after treating the OI.