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HIV/AIDS

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Deciding whether to start therapy

for Veterans and the Public

Starting therapy

HIV drugs are essential in keeping people healthy over the years. For people who are sick from HIV, they can be lifesavers. Effective treatment stops or slows the progression of HIV and has important benefits, even for persons whose immune systems appear to be functioning relatively well. Thus, HIV drugs are recommended for ALL people with HIV infection, whether they are sick or well. And, in general, starting treatment early after someone is diagnosed with HIV is better than delaying, so long as you are ready to start.

For people whose immune systems are weaker, starting treatment is urgent. For people whose immune systems are still strong, it is important to start HIV medications before their immune systems suffer more. Studies show that starting treatment early is the most effective way to prevent long-term consequences of HIV. And, treatment that suppresses the HIV virus can prevent transmission (spread) of HIV infection to sex partners (or injection drug use partners); for pregnant women, it ccan prevent infection of the baby in the womb or at birth.

There a couple of things to know about as you decide when to start treatment. First, the current drug regimens usually are very simple and compact (between 1 and 3 pills per day), and they usually work very well, so long as you take them every day. Second, it's really important to take the medicines correctly every day or the virus may become resistant to the drugs. That means the virus may change in a way that makes the drugs no longer work. The most common cause of drug resistance is not taking medications correctly every day. So, people need to be ready to commit to taking the medications every day (we call this "adherence"). And third, HIV medicines, like any other drugs, may cause side effects in some people. But people who take the newer HIV drugs usually do not have any problems with them. If you do have side effects, let your health care providers know so that they can work with you to solve this problem.

So, as we said earlier, treatment of HIV is recommended for all people with the infection. Experts generally advise starting treatment soon after you are diagnosed with HIV, and your clinician may even offer you treatment on the same day you receive your diagnosis. Here are some things your health care provider may consider in advising you how quickly to start:

  • Symptoms of HIV disease (also called your clinical status, or how well you feel)
  • Your CD4 count and HIV 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 (adherence)
  • Whether you have sex partner(s) who are HIV-negative and may be at risk of becoming infected through you.
  • Whether you are pregnant or wish to become pregnant soon.

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 can 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 multiply 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. The CD4 count tells us how many CD4 cells you have. The higher the number, the better.

The HIV viral load test indicates how much of the HIV virus is present in your blood, and how fast it is multiplying. 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 before treatment is started and then regularly while someone is on treatment. For people who decide to delay starting treatment, these tests are done every 3 months; they can help you and your health care provider decide how urgent it is to start anti-HIV drugs. As we said earlier, HIV medicines are recommended for everyone, no matter how high or low their CD4 count is. And HIV treatment is especially urgent if your CD4 count is lower, or if you have symptoms. The lower the CD4, the more important it is to start treatment quickly. For more information about CD4 count and viral load, go to Understanding Laboratory Tests.

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)

Before you start medications for HIV, it is very important to make a strong commitment to sticking to a drug therapy plan (or regimen). With an HIV drug regimen, you will need to take medicines every day!

In order for the drugs to work and keep working, you must carefully follow the directions for taking them. 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 treatment 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 sex partners or during pregnancy

HIV therapy has been shown to greatly reduce the risk of transmitting HIV to uninfected sex partners. In fact, if you take your medicines every day and your HIV treatment is working well, there is almost no risk of transmitting HIV to a sex partner. Thus, if you have a sex partner who is HIV negative, you may consider starting HIV treatment both to protect and improve your own health and to prevent transmission to partners. Similarly, if you are pregnant or intend to become pregnant, it is important to start HIV medications right away both to protect your own health and to reduce the risk of passing HIV to the baby during pregnancy or at the time of birth.