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FAQ: When should you start antiretroviral therapy?

for Veterans and the Public

Frequently Asked Questions

Q: When should you start antiretroviral therapy?

Treating HIV with antiretroviral medications can have huge benefits for you as an individual, and for anyone who is at risk of being infected with HIV (like a sex partner). HIV therapy helps to:

  • reduce the amount of HIV in your body
  • strengthen your immune system
  • prevent illness
  • help you live longer
  • prevent transmission (passing the virus) to your sex partner(s)

The question of when to start taking HIV medications has been debated for many years, and the answer has changed over time.

Until recently, most guidelines recommended waiting until the CD4 (or "T cell") count dropped to a certain level before starting HIV medications. This was because our understanding of the damaging effects of HIV was not as full, and because the available HIV medications were harder to take than they are now (for example, greater numbers of pills, more side effects) and not as likely to be effective.

In the past few years, more studies have shown that starting HIV treatment earlier can lower the risk of a variety of illnesses related to the effects of HIV. In other words, HIV medications can help people stay healthier if they start the meds when their CD4 counts are higher. Also, we now have strong proof that effective HIV therapy dramatically reduces the chance of HIV passing from an HIV-positive person to an HIV-negative sex partner. And--more good news--many of the newer HIV medications are better, easier to take, and consist of fewer pills.

While there may be some individuals in whom it is best to delay treatment temporarily, current guidelines recommend starting therapy for ALL persons with HIV infection, so long as they are willing and able to take the medications.