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What does HIV treatment do?

HIV treatment keeps the virus under control by stopping it from reproducing itself. The goal is to keep levels of HIV so low that in tests the person has an ‘undetectable’ viral load.

What does being ‘undetectable’ mean?

An ‘undetectable’ viral load doesn’t mean HIV is not there, just that the amount of the virus in the blood is too low for tests to pick up. Viral load can increase again if the person with HIV stops taking their treatment.

The British HIV Association (BHIVA) now recommends that everyone diagnosed with HIV starts treatment straight away. This is because starting earlier is proven to keep people with HIV healthier.

Additionally, people on effective treatment, with undetectable viral load, have little to no risk of transmitting the virus to HIV negative people.


Treatment as Prevention (TasP)

The lower the amount of HIV in the blood, the better for someone’s health. It also means they are less infectious.

Treatment as Prevention (TasP) means placing HIV positive people on HIV treatment in order to make them less infectious and unlikely to pass on HIV if they have sex without a condom.

This effect of HIV treatment has been confirmed by the findings of the PARTNER study - which is investigating whether people with an undetectable viral load can still be infectious.

The interim results of this study have shown that someone who is HIV positive and on treatment, with an undetectable viral load, has a very low to zero chance of infecting their sexual partner with HIV.

So far the study found no cases of HIV being transmitted in 16,400 occasions of gay sex and 28,000 cases of heterosexual sex where the HIV positive partner had an undetectable viral load.

Based on the interim results, some monogamous couples are judging it safe to have condomless sex if they meet these criteria.


When should people with HIV start treatment?

It is now recommended that everyone diagnosed with HIV starts treatment straight away – regardless of their CD4 count.

In the UK, the BHIVA guidelines set out standards for HIV treatment. These guidelines were changed in September 2015 to say that anyone with HIV who is ready to commit to treatment should start taking it.

This change reflects the findings of another study, called the START study.

The START study found that people who waited to start treatment until their CD4 count dropped to 350 (which is when people were previously advised to start treatment) had a much higher chance of developing AIDS-related illnesses.

Treatment is working well if tests show someone has a high number of CD4 cells and a low level of HIV in their body.


What does ‘adherence’ mean and why is it important?

People take far fewer pills now than in the past -- sometimes just one or two per day. Once treatment starts they must be taken every day.

Sticking to the daily dose is called ‘adherence’ and good adherence is vital if treatment is to work.

If even just a few doses are missed the levels of drugs in the body fall, allowing HIV to develop resistance to them, meaning they stop working as they should.

Someone who keeps missing doses may see their viral load go up, which is bad for their health and will make them more likely to pass on HIV if they have condomless sex.


What are the side effects of HIV treatment?

HIV drugs have become more effective and easier to take. Earlier problems with side effects (such as visible changes to the face and body, called lipodystrophy) are now rare.

People may experience side effects during the first weeks of treatment (eg headaches, diarrhoea or feeling sick or tired) but once the body gets used to the drugs, these get better or go away completely.

HIV doctors work closely with their patients when treatment begins in order to find the best tolerated drug, with minimal side effects.

Your doctor will also regularly monitor your blood to check for any other issues that might be related to taking HIV drugs, and treat them if necessary.

The risks of not taking HIV medication are far greater than any risk from being on treatment.

Without treatment serious illness and death will follow within a few years for nearly everyone with HIV.


Does HIV treatment cure HIV?

Antiretrovirals are not a cure for HIV because they cannot completely rid the body of the virus. HIV lives on in parts of the body that drugs can’t reach – these are called ‘reservoirs’.

For this reason HIV treatment is life-long.


How long can people on HIV treatment live?

Thanks to HIV drugs, doctors now see the infection as something that people can live very well with for a lifetime.

This is especially true if they are diagnosed early and start medication before the virus does too much damage to their immune system, in which case a person can expect to live as long as someone who doesn’t have HIV.

Thanks to medication, HIV-related illness and deaths have dropped dramatically.


PEP - Post-exposure prophylaxis ››

‹‹ Back to: HIV postal testing with Fastest Direct

 

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The Information Standard: Certified member

This article was last reviewed on 22/3/2016 by Anna Peters

Date due for the next review: 21/4/2019

Content Author: Kerri Virani

Current Owner: Health promotion

More information:

Pragmatic Open-Label Randomised Trial of Pre-Exposure Prophylaxis: the PROUD study, PROUD, MRC Clinical Trials Unit & Public Health England, February 2015

PROUD study interim analysis finds pre-exposure prophylaxis (PrEP) is highly protective against HIV for gay men and other men who have sex with men in the UK, PROUD, MRC Clinical Trials Unit & Public Health England, October 2014

Viral load and transmission - a factsheet for HIV negative people, by Gus Cairns, NAM, Aidsmap, 16/9/15

Viral load and transmission – a factsheet for people with HIV, by Gus Cairns 16/9/15, NAM, Aidsmap

Is there a cure for HIV and AIDS?, Avert, 1/5/15

Early antiretroviral treatment reduces but does not eliminate HIV reservoir, by Liz Highleyman, NAM, Aidsmap, 24/3/15

What are normal ranges for a CD4 count, the CD4% and the CD4:CD8 ratio?, by Simon Collins, iBase, 19/9/14

How HIV destroys the immune cells, by Dan Cossins, The Scientist, 19/12/13

CD4 cell counts, NAM, Aidsmap, February 2012

The basics - CD4 and viral load booklet, NAM, Aidsmap, February 2012

Adherence, by Michael Carter & Greta Hughson, NAM, Aidsmap, 31/3/12

What does taking your HIV treatment involve?, NAM, Aidsmap, March 2014

Aids info - Education materials - Viral rebound

Common side effects - From Side Effects booklet, NAM, Aidsmap, July 2013

Changing treatment due to side effects, by Michael Carter & Greta Hughson, NAM, Aidsmap, 31/3/12

Monitoring the safety and effectiveness of HIV treatment - From Taking Your HIV Treatment booklet, NAM, Aidsmap, March 2014

How long will I live if I stop taking my HIV medication? - Question answered by Angelina Namiba, iBase, 19/1/12

Prognosis, by Michael Carter & Greta Hughson, NAM, Aidsmap, 13/3/12

HIV basics - What is the life expectancy of someone with HIV?, NAM, Aidsmap

Is treatment prevention?, NAM, Aidsmap

No one with an undetectable viral load – gay or heterosexual – transmits HIV in first two years of PARTNER study, NAM, Aidsmap

BHIVA guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015, Writing Group: Duncan Churchill Chair Laura Waters Vice Chair N Ahmed, B Angus, M Boffito, M Bower, D Dunn, S Edwards, C Emerson, S Fidler, †M Fisher, R Horne, S Khoo, C Leen, N Mackie, N Marshall, F Monteiro, M Nelson, C Orkin, A Palfreeman, S Pett, A Phillips, F Post, A Pozniak, I Reeves, C Sabin, R Trevelion, J Walsh, E Wilkins, I Williams, A Winston

START trial finds that early treatment improves outcomes for people with HIV, NAM, Aidsmap, Gus Cairns, 27/5/15

START trial provides definitive evidence of the benefits of early HIV treatment, NAM, Aidsmap, Liz Highleyman; Produced in collaboration with hivandhepatitis.com, 21/7/15

Your treatment. NAM. 

HIV Basic Treatment. NAM.

Anti-HIV drugs. NAM.

Progression to AIDS or death. NAM.  

People doing well on HIV therapy have a mortality risk identical to that of HIV-negative peers. NAM.

Decrease in AIDS-related illness and deaths. NAM.  

Lipodystrophy. NAM.

Link with reduced infectiousness and good adherence. BHIVA.

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