When to Start Treatment?

Part of HIV Medications: When to Start and What to Take

Doctors still disagree about when is the best time to begin HIV treatment, also called antiretroviral therapy. You and your doctor will need to determine this together, but there are some respected guidelines. Be aware that these guidelines are regularly updated and are not hard-and-fast rules. They are just suggestions based on the most recent research.

Current HIV/AIDS Guidelines Recommend
  • If your T-cell count is above 500, you can hold off on HIV medications, but many experts feel it's good to start, just to be safe.
  • If your CD4 count is between 350 and 500, you should begin treatment to protect your immune system from future damage.
  • If your T-cell count is below 350, or if you've ever had an AIDS-defining illness, you should start treatment immediately to avoid serious health problems.

In the U.S., the most respected HIV treatment guidelines are created by a team of experts brought together by the U.S. Department of Health and Human Services, or DHHS for short.

Once you start taking HIV medications, you'll probably have to take them for a very long time, so you and your doctor will want to make sure you are absolutely ready before you begin treatment. This way you can postpone possible medication side effects (which we talk about later in this booklet) and make the most of the powerful initial effect medications can have on the HIV in your body.

What Is a T-Cell or CD4 Count?

Your T-cell count, also known as a CD4 count, reveals the number of T cells in your body. A T cell is a special kind of white blood cell, and the more you have, the stronger your immune system is. When you were infected with HIV, the virus entered into some of your T cells. When these HIV-infected T cells make more co-pies of themselves, they end up making more copies of HIV as well. HIV can also destroy T cells, as well as other surrounding cells. After living with HIV for a while (if you don’t take medica-tions) the number of T cells you have will usually go down. This is a sign that your immune system is being weakened. The lower your T-cell count, the more you risk getting sick. A normal T-cell count for someone without HIV is usually be-tween 500 and 1,600.

What Is Viral Load?

Viral load levels tell you and your doctor how much HIV is circulating in your blood. The more HIV in your system, the quicker your T-cell count tends to drop. This makes viral load a helpful predictor of the health problems you may develop if you do not take medication. It is also a good measure of how well HIV medications are working once you begin treatment.

Your viral load count measures the amount of HIV per milliliter (mL) of your blood. Current viral load tests can detect as few as 50 copies of HIV per milliliter of blood. When you have fewer than 50 copies/mL of HIV, your doctor will tell you that your viral load is "below the limit of detection," or "undetectable." This does not mean that there is no more HIV in your body. So even if you are "undetectable," you can still transmit HIV to someone.

Getting Into Good Habits Before You Start Treatment

Even if you're not about to begin HIV treatment, now's the perfect time to revisit some of your habits to be sure they're healthy. Even the most effective HIV medications can't overcome an unhealthy lifestyle.

Now is the time to begin eating healthier, exercising regularly, and cutting out cigarettes, recreational drugs or excessive use of alcohol -- all of which have been shown to have a dangerous effect on the immune systems of people with HIV.

In addition, it's important for you and your HIV doctor to have a full picture of everything you're putting into your body. If you are taking any prescription drugs, over-the-counter medications, vitamins or supplements -- any at all, no matter how unimportant they seem -- make sure you tell your doctor so that you can avoid dangerous interactions with HIV medications.

For example, antihistamines, birth-control pills and recreational drugs all have been shown to have serious interactions with some HIV medications. Even the seemingly harmless herb St. John's wort can reduce the strength of some HIV meds.

Can You Really Talk to Your Doctor?

Does he or she listen to you? Choosing a doctor you can talk to is crucial. You’ll probably have many questions; make sure your doctor is available and able to answer them before you make any decision about starting HIV treatment.