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When to start HIV treatment

starting treatment

Treatment guidelines recommend that everyone with HIV starts treatment whatever their CD4 count. Effective treatment protects your immune system and ensures that if your viral load is undetectable, you cannot pass on HIV.

What will happen if I don’t take HIV treatment?

Eventually, nearly everyone with HIV will become ill without treatment.

If you're not on effective HIV treatment, the virus can attack and weaken your immune system (the body’s natural defence against infections).

Over time, when HIV has done a lot of damage to your immune system, you're likely to become vulnerable to infections that you would otherwise have been able to fight off.

HIV also causes inflammation in various parts of the body. This can increase the risk of a number of illnesses: cardiovascular disease (for example, heart attack and stroke), kidney or liver problems and some cancers.

The damage that HIV causes happens slowly, often over a number of years. It can be the case that a person feels well during this time.

Treatment protects you. A person with HIV who is taking treatment and has an undetectable viral load cannot pass on HIV and can expect to live a normal lifespan.

It can take up to six months on treatment to become undetectable.

When should I start HIV treatment?

You should start taking HIV treatment as soon as you're diagnosed.

Until recently, people living with HIV were advised to start treatment before their CD4 count dropped to 350 or below.

The British HIV Association (BHIVA) now recommends that anyone with HIV who is ready to commit to treatment should start taking it regardless of CD4 count.

Those changes reflect the findings of the START study. It found that people who delayed treatment until their CD4 count dropped to 350 had a significantly higher chance of developing AIDS-related illnesses such as cancers.

The advantages of taking HIV treatment:

  1. Once your viral load is undetectable, you cannot pass on HIV to partners. (It might take up to six months on treatment to become undetectable.)
  2. You may have less illness, if HIV has been making you ill.
  3. The treatment will stop HIV from reproducing in your body.
  4. Your immune system will get stronger.

What if I don’t want to start HIV treatment yet?

In the past people could delay treatment if they weren’t ready to start. However, this isn’t recommended now.

The START trial found that there was a 53% reduction in the risk of death or serious illness if treatment was started when the CD4 count was still above 500.

But I’m nervous about starting treatment

It’s common for people to feel apprehensive about taking treatment but all you need to remember is that:

  • it will enable you to live a normal lifespan
  • if it is effective (meaning you have been taking it as prescribed for at least six months and are undetectable) you won't be able to pass on HIV.

If you're nervous a healthcare professional at your clinic will be able to reassure you. They'll be able to explore with you the reasons why you don't want to start. You can also contact THT Direct on 0808 802 1221 for support around your decision.

Next: Dealing with side-effects of HIV treatment ››

‹‹ Back to: About HIV treatment

Quote reading

See also: Full HIV medication listings ›››



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This article was last reviewed on 1/11/2015 by Anna Peters

Date due for the next review: 1/11/2018

Content Author: Kerri Virani

Current Owner: Kerri Virani

More information:

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HIV treatment as prevention and HPTN 052, Cohen MS1, McCauley M, Gamble TR
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