Starting treatment

The results of the regular blood tests you have as part of your HIV care can help you and your doctor decide whether you should start treatment. But there will be other factors to take into account.

It’s unlikely that you will have to make a quick decision - you will probably have an opportunity to consider the pros and cons over a period of time.

If your CD4 cell count is already very low or you are ill with an infection, you may need to make a decision more quickly. Your doctor may advise you to start HIV treatment urgently, in order to prevent serious illness and infections. If your CD4 cell count is 350 or below, you are recommended to discuss HIV treatment with your doctor and to start treatment as soon as you are ready.

If you are ill because of HIV, have another health condition or you are above the age of 50, you may be advised to start treatment earlier – when your CD4 count is around 500.

Starting treatment when your CD4 cell count is around 350 reduces the risk of developing some other serious illness. These include cardiovascular diseases (heart attack and stroke, for example), liver or kidney problems and some cancers.

Taking HIV treatment reduces the amount of virus in your blood and other body fluids, including semen and vaginal fluids. This reduces the risk of HIV being passed on to others. You may want to consider starting treatment earlier if you have an HIV-negative partner, for example. . Your doctor may talk to you about this, or you could raise it with them.

Some doctors think there are advantages to starting HIV treatment at higher CD4 cell counts. They point to lower rates of illness and death among people who started treatment when their CD4 cell count was around 500. The pros and cons of starting treatment at CD4 cell counts above 350 are still uncertain for most people, but the recommendations for when to start may change in the future.

If your doctor recommends that you start treatment but you decide that you would rather not start yet, it is very important that you stay in touch with your clinic and have your health monitored regularly.