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 ››
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