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Deciding whether to start therapy

for Veterans and the Public

Deciding whether to start therapy

HIV drugs can be lifesavers, and are very important in keeping people healthy over the years. Effective treatment stops or slows the progression of HIV. In recent years, scientists have been learning more about the benefits of treatment even for persons whose immune systems appear to be functioning relatively well. Thus, in general, HIV drugs are recommended for ALL people with HIV infection, whether they are sick or well (though starting treatment is more urgent for people whose immune systems are weaker).

However, there are reasons some people may not start taking HIV treatment right away. For one thing, the medications must be taken correctly every day or the virus may become resistant to drugs. That means the virus may change in a way that makes the drug no longer work. The most common cause of drug resistance is not taking medications correctly. Also, HIV medicines, like any other drugs may cause side effects in some people. But for most people the newer HIV drugs are quite tolerable. In addition, the drug regime typically is simple and compact (usually between 1 and 3 pills per day).

As we said earlier, treatment of HIV is recommended for all people with the infection. In terms of exactly when to start the drugs, experts say you can consider these things:

  • Symptoms of HIV disease (also called your clinical status, or how well you feel)
  • Your CD4 count and viral load
  • Whether you have certain other medical conditions that may be helped by HIV treatment
  • Whether you can and will stick to your treatment plan (called adherence)
  • Whether you have sex partner(s) who are HIV-negative and may be at risk of becoming infected through you.

We will look at each of these more closely.

Symptoms (clinical status)

"Clinical status" refers to how well you are doing in general, including how well you feel. Your doctor will look at whether you have symptoms of HIV disease. These symptoms are signs that HIV is weakening your immune system, and include things such as weight loss, chronic fevers, and opportunistic infections. (Opportunistic infections--also called OIs-- are infections that happen in someone with a damaged immune system.)

CD4 count and viral load

Even though you may not feel it, when you have HIV, the virus and your immune system are at war with each other. The virus is trying to grow as fast as it can, and your body is trying to stop it. Two tests, the CD4 count and the HIV viral load, help you and your health care provider know how strong your immune system is, and know whether it is keeping HIV under control.

CD4 cells play a major role in helping your immune system work properly. HIV causes disease by killing off CD4 cells. It does this by infecting the cells and turning them into virus factories, a process that kills the cell. A test called the CD4 count can tell you how many CD4 cells you have. The higher the number, the better. The test, however, doesn't tell you if those CD4 cells are working properly.

The viral load test indicates how much of the HIV virus is present in your blood, and how fast it is growing. The higher the viral load, the faster HIV is infecting and killing your CD4 cells. The lower the viral load, the better.

Your health care provider will look at these two things carefully. People whose CD4 count is low, and people whose viral load is high, are more likely to get sick sooner than people with a high CD4 count and low viral load.

CD4 count and viral load tests usually are done every 3 months. Results can help you and your health care provider decide how urgent it is to start anti-HIV drugs. The U.S. Department of Health and Human Services makes general recommendations regarding when HIV-positive people should start taking HIV drugs. These are not firm rules, just guidelines. These guidelines recommend HIV drugs for everyone, no matter how high or low their CD4 count is. However, they say that HIV treatment is especially important if your CD4 count is lower, or if you have symptoms. The lower the CD4, the more important it is to start treatment quickly.

Whether you have certain other medical conditions that may be helped by HIV treatment

Starting HIV drugs may be particularly important for people with certain other medical conditions. For example, your doctor will recommend HIV therapy if you are pregnant or plan to become pregnant, if you have kidney disease that is caused by HIV, or if you have hepatitis B or hepatitis C.

Whether you can and will stick to your treatment plan (adherence)

It is very important to start drug therapy only when you are ready to make a strong commitment to sticking to a drug therapy plan (or regimen). With an HIV drug regimen, you will need to take pills every day!

In order for the drugs to work and keep working, you must follow the directions for taking them very carefully. If you're not sure you can do this, you might need help in finding ways to stick to the plan.

If you are wondering whether you should start taking drugs for HIV, you should sit down and talk with your provider as soon as possible. Depending on your specific needs, your provider can come up with a personal treatment plan for you.

Risk of transmitting HIV to sexual partners

HIV therapy has been shown to reduce the risk of transmitting HIV to uninfected sex partners. Thus, if you have a sexual partner or who is HIV-negative, you may consider starting HIV treatment both to protect and improve your own health and to prevent transmission to partners.