Day One: After You've Tested Positive

When to Start Treatment

Getting the earliest possible treatment is generally recommended for treating illnesses. Biologically, there's little reason to think that HIV is any different. In fact, early treatment may be even more important because of the seriousness of the disease. But just what "early" means in the case of HIV disease is not so clear.

When to start HIV medicines is the subject of a great deal of debate and theory. Some people believe that starting treatment is appropriate immediately upon learning of the infection, whether or not your CD4 count is falling, viral load is high or rising, or whether symptoms are evident. Waiting might only let the infection progress and spread to other parts of the body.

A second argument in favor of early treatment is that this may prevent losing critical cells in your immune system. But since we don't know exactly when the loss of these cells occurs, it's still hard to know "when" is the right time to start.

Some researchers prefer to withhold treatment until later in the disease. They believe it is best to save the drugs for later when HIV is more active or when your immune system shows obvious damage. They fear that treating too early may "use up" the medicines before they're most critically needed. They also fear that people will have long-term side effects from the drugs before they're truly needed.

Since none of the current drugs can be used indefinitely, this argument cannot be casually dismissed. However, even these researchers believe it's wise to start before there's evidence of major damage to the immune system. Just "when" that occurs is unclear. Almost all researchers agree that it's necessary to start HIV therapy when symptoms are present, your CD4 count is falling, or your viral load is high.

We will get clearer answers to these questions as more studies are completed. In the meantime, the question remains a matter of personal choice. For information about HIV therapy, developing a long-term strategy and making decisions about therapies, call Project Inform's National HIV/AIDS Treatment Hotline at 1-800-822-7422, or email a question to our operators.

Available Treatments Project Inform provides information on using proven HIV treatments. These and any other treatments should only be used under the care of an experienced doctor. We encourage patients and doctors to enter into collaborative relationships with shared responsibility for reaching and maintaining your health. Treatment should always occur with monitoring, which evaluates the success or failure of treatment as well as monitors for side effects. Both patient and doctor should be prepared to adjust the strategy based on the results of this monitoring process. This model of flexible, monitored treatment used in the context of a collaborative doctor/patient relationship is the key to managing HIV as a chronic illness. Complete information on treatments is readily available, along with discussion papers on related topics. Just ask for the basic "treatment package." The latest information on these and other important treatment issues is available through Project Inform's National HIV/AIDS Treatment Hotline at 1-800-822-7422. Also, there are many other magazines and newsletters for persons with HIV.

The Bottom Line

• HIV infection is not a death sentence; you'll be OK for quite some time, no matter what happens.
• You can gain power over your HIV by learning how it operates.
• Learn to check on your health and understand the common lab tests.
• Get acquainted with Project Inform's five-step model.
• Get informed about your treatment options.
• Develop a treatment strategy that makes sense for you.

Project Inform provides more than a hundred publications designed to make information about living with HIV disease, medical therapies, research advances, and public policy issues easier to understand. All of these publications are available free of charge through Project Inform's National HIV/AIDS Treatment Hotline at 1-800-822-7422 and website.