What Is the Next Step After Testing Positive for HIV?
Testing positive for HIV often leaves a person overwhelmed with questions and concerns. It's important to remember that HIV is a manageable disease that can be treated with HIV medicines.
The first step after testing positive is to see a health care provider, even if you don't feel sick. People with HIV work closely with their health care providers to decide when to start HIV medicines and what HIV medicines to take.
The use of HIV medicines to treat HIV infection is called antiretroviral therapy (ART). People on ART take a combination of HIV medicines (called an HIV regimen) every day. ART prevents HIV from multiplying and reduces the amount of HIV in the body. ART can't cure HIV, but it helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.
People with HIV should start ART as soon as possible. In people with HIV who have certain conditions, such as certain HIV-related illnesses and coinfections, it's especially important to start ART right away. Deciding when to start ART and what HIV medicines to take begins with an HIV baseline evaluation.
What Is an HIV Baseline Evaluation?
An HIV baseline evaluation includes all the information collected during a person's initial visits with a health care provider. The HIV baseline evaluation includes a review of the person's health and medical history, a physical exam, and lab tests.
The purpose of an HIV baseline evaluation is to:
- Determine how far a person's HIV infection has progressed. Treatment with HIV medicines can prevent HIV from advancing to AIDS. AIDS is the final stage of HIV infection.
- Evaluate whether the person is ready to start lifelong treatment with HIV medicines.
- Collect information to decide what HIV medicines to start.
During an HIV baseline evaluation, the health care provider explains the benefits and risks of HIV treatment and discusses ways to reduce the risk of passing HIV to others. The health care provider also takes time to answer any questions.
What Are Some Questions People Typically Ask During Their First Visits With an HIV Health Care Provider?
People with newly diagnosed HIV infection can have many questions. If you've just tested HIV positive you may have some of the following questions:
- Because I have HIV, will I eventually get AIDS?
- What can I do to stay healthy and avoid getting other infections?
- How can I prevent passing HIV to others?
- How will HIV treatment affect my lifestyle?
- How should I tell my partner that I have HIV?
- Is there any reason to tell my employer and those I work with that I have HIV?
- Are there support groups for people with HIV?
Many people find it helpful to write down questions before a medical appointment. Some people bring a family member or friend to their HIV appointments to remind them of questions to ask and to write down the answers.
What Lab Tests Are Included in an HIV Baseline Evaluation?
The following lab tests are included in an HIV baseline evaluation.
A CD4 count measures the number of CD4 cells in a sample of blood. CD4 cells are infection-fighting cells of the immune system. HIV destroys CD4 cells, which damages the immune system. A damaged immune system makes it hard for the body to fight off infections. Treatment with HIV medicines prevents HIV from destroying CD4 cells. The higher a person's CD4 count is, the better.
ART is recommended as soon as possible for everyone with HIV, no matter what their CD4 count is. However, a low CD4 count (below 200 cells/mm3) increases the urgency to start ART.
A viral load test measures how much virus is in the blood (HIV viral load). A goal of HIV treatment is to keep a person's viral load so low that the virus can't be detected by a viral load test.
The CD4 count and viral load test are both used to monitor the effectiveness of HIV medicines once ART is started.
Drug-resistance testing identifies which, if any, HIV medicines will not be effective against a person's strain of HIV. Health care providers consider a person's drug resistance test results when recommending an HIV regimen.
Testing for Sexually Transmitted Diseases (STDs)
Coinfection with another STD can cause HIV infection to advance faster and increase the risk of HIV transmission to a sexual partner. STD testing makes it possible to detect and treat any STDs promptly.
An HIV baseline evaluation also includes other tests, such as a blood cell count, kidney and liver function tests, tests to check the levels of glucose and certain fats in the blood, and tests for hepatitis.
To learn more, view the AIDS_info_ infographic: What do my lab results mean?
How Does an HIV Baseline Evaluation Help Determine If a Person Is Ready to Start HIV Treatment?
Before starting treatment, people with HIV must be prepared to take HIV medicines every day for the rest of their lives. A baseline evaluation can help to identify any issues that can make it difficult to take HIV medicines every day and exactly as prescribed (called medication adherence).
Issues, such as lack of health insurance or alcohol or drug use that interferes with the activities of daily life, can make medication adherence difficult. Health care providers can recommend resources to help people deal with any issues before they start taking HIV medicines.
How Can I Find More Resources for a Person Who Has Just Tested HIV Positive?
The following are resources to share with someone newly diagnosed with HIV:
- How to Find HIV Treatment Services, a fact sheet listing HIV-related resources including resources to help find a health care provider and get help paying for HIV medicines, from AIDS_info_.
- Question Builder, a tool to use to create a list of questions to ask a health care provider, from the Agency for Healthcare Research and Quality.
- Talking About Your HIV Status, a webpage with tips on how to share an HIV diagnosis with others, from HIV.gov.
This fact sheet is based on information from these sources:
- From the Department of Health and Human Services: Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV: Baseline Evaluation, Laboratory Testing for Initial Assessment and Monitoring of Patients with HIV Receiving Antiretroviral Therapy, and Initiation of Antiretroviral Therapy
- From the Department of Veterans Affairs: Just Diagnosed
- From the Health Resources and Services Administration: Guide for HIV/AIDS Clinical Care: Testing and Assessment
[Note from TheBody: This article was originally published by AIDSinfo on Feb. 6, 2018. We have cross-posted it with their permission.]