

Why is treatment necessary?

This does not, however, include people who take HIV drugs. Clinical trials—studies in which new and old drugs are tested in humans—have repeatedly shown that HIV drugs can keep HIV-infected people alive longer. Treatment, therefore, is a very important option, and people living with the virus should consider starting treatment before HIV has had a chance to do serious damage to their immune systems. Experts believe that people who start HIV treatment while their immune systems are still within normal parameters have the greatest chance of living out something close to a normal life span.

Recent evidence, however, suggests that mild-to-moderate immune damage earlier in the course of disease, as well as inflammation due to actively reproducing virus, might increase a person's risk for non-AIDS-defining illness such as cardiovascular disease, kidney disease, liver disease and certain cancers. This evidence has prompted experts to recommend treatment earlier than they have done in the past.


When should treatment be started?
The U.S. Department of Health and Human Services (DHHS)—the federal agency responsible for setting health-related policies in the United States—regularly updates and publishes HIV treatment guidelines to help HIV-positive patients and their health care providers determine when antiretroviral therapy should be started. Here is what the guidelines, last updated in January 2016, recommend:




A person’s viral load—the amount of HIV in a milliliter of blood—was also widely used to help patients and their health care providers decide when to begin treatment. The higher the viral load, experts suggested, the faster someone might see his or her CD4 cell counts fall to dangerously low levels. Even if a patient had a relatively healthy CD4 count, treatment might still be recommended if he or she had a high viral load. Today, viral load isn't commonly used to figure out when therapy should be started. But viral load testing is still a routine component of HIV treatment, notably to help patients and their doctors determine if treatment is working correctly.

Do I really need to start HIV treatment immediately?



Potential Benefits

  • Decrease your risk of certain HIV-related health problems that can sometimes occur in people with high CD4 counts, including tuberculosis, non-Hodgkin's lymphoma, Kaposi's sarcoma, peripheral neuropathy, cancers and pre-cancers caused by human papillomavirus (HPV), and mental deficits seen in some people with HIV, such as difficulty thinking and reasoning (neurocognitive problems).
  • Reduce your risk of transmitting HIV to others—several studies have confirmed an association between undetectable viral loads and a greatly reduced risk of transmitting the virus, notably during sexual activity and pregnancy. One clinical trial in particular (HPTN 052), involving mixed-status heterosexual couples, found that treating HIV-positive people with ARV drugs reduces the risk of transmitting the virus to HIV-negative sexual partners by 96 percent.

Potential Risks

  • Risk developing treatment-related side effects, including long-term side effects that haven't yet been discovered.

What if I’m pregnant?

How do I know my treatment is working?
When HIV drug therapy is started—preferably with a powerful combination of drugs—the level of HIV should start to drop dramatically. This is where viral load testing comes in. During the first two months of therapy, an HIV-infected person's viral load should drop a minimum of 90 percent. In other words, someone who starts treatment with a viral load count of 100,000 should drop to 10,000 or less within two months. Within 4 to 6 months of starting therapy, the viral load should have dropped a lot more, hopefully below the level of the viral load test's sensitivity ("undetectable"). Sometimes undetectable means a count less than 400 or 500, but most tests used today can detect as few as 50. Generally, the higher your viral load is before starting therapy, the longer it will take to become undetectable.




You should also have your CD4 cell count checked regularly—usually every 3 to 6 months. Additional tests that your health care provider should monitor to ensure that you are not experiencing certain side effects include proteins associated with liver and kidney health, your cholesterol and your blood sugar.


Last Revised: February 14, 2016