When should I start antiretroviral treatment?

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Without treatment, people living with HIV can become ill because of the damage HIV does to the immune system. The immune system is your body’s way of protecting itself from illnesses caused by germs, bacteria or infections.

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It is now recommended that people living with HIV start antiretroviral treatment straight away. This is being implemented in an increasing number of countries. In some places, the decision about when to start treatment is still dependent upon a CD4 count test, which looks at how many CD4 cells are in a small amount of blood.

 

The CD4 cells (also called T-helper cells) are an important part of the immune system because they fight germs and infections. HIV attacks CD4 cells and reduces the number of them in your body. Without treatment, HIV slowly weakens the immune system, making it harder for your body to fight off illness or infection.

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What is the best HIV treatment to start with?

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The drugs used to treat HIV are called antiretroviral drugs (ARVs). There are several different types and they work in different ways. HIV treatment is made up of three or more antiretroviral drugs taken together. Sometimes, these drugs are combined into one pill.

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There are lots of antiretroviral drugs, and they can be combined in different ways. The World Health Organization (WHO) has recommended a combination of antiretroviral drugs for people starting HIV treatment:

• TDF (tenofovir)

• either 3TC (lamivudine) or FTC (emtricitabine)

• and EFV (efavirenz).

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WHO has also recommended alternative combinations. Your doctor will be able to tell you which drugs are best for you.

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What is an HIV regimen?

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An HIV regimen is a combination of HIV medicines used to treat HIV infection. HIV treatment (also called antiretroviral therapy or ART) begins with choosing an HIV regimen. People on ART take the HIV medicines in their HIV regimens every day. ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.

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There are more than 30 HIV medicines approved by the U.S. Food and Drug Administration (FDA) to treat HIV infection. Some HIV medicines are available in combination (in other words, two or more different HIV medicines combined in one pill).

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The U.S. Department of Health and Human Services (HHS) provides guidelines on the use of HIV medicines. In general, the guidelines recommend starting ART with a regimen that includes three HIV medicines from at least two different drug classes.

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What factors are considered when choosing an HIV regimen?

The choice of HIV medicines to include in an HIV regimen depends on a person’s individual needs. When choosing an HIV regimen, people with HIV and their health care providers consider the following factors:

• Other diseases or conditions that the person with HIV may have, such as heart disease or pregnancy.

• Possible side effects of HIV medicines.

• Potential interactions between HIV medicines or between HIV medicines and other medicines the person with HIV is taking.

• Results of drug-resistance testing (and other tests). Drug-resistance testing identifies which, if any, HIV medicines won’t be effective against a person’s HIV.  

• Convenience of the regimen. For example, a regimen that includes two or more HIV medicines combined in one pill is convenient to follow.

• Any issues that can make it difficult to follow an HIV regimen. For example, a busy schedule can make it hard to take HIV medicines consistently every day.

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How long does it take for ART to work?

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Viral load is the amount of HIV in a person’s blood. A main goal of ART is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. 

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Once effective ART is started, it usually takes 3 to 6 months for a person’s viral load to reach an undetectable level. Having an undetectable viral load doesn’t mean a person’s HIV is cured.

 

Although there is still some HIV in the person’s body, an undetectable viral load shows that ART is working effectively to keep the person’s HIV under control. In addition, people with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partner through sex.

 

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What Does Undetectable Mean?

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• A person living with HIV is considered to have an ‘undetectable’ viral load when antiretroviral treatment has brought the level of virus in their body to such low levels that blood tests cannot detect it.

• There is no risk of passing on HIV if your doctor has confirmed that you are undetectable (or virally suppressed), you continue taking your treatment and attend regular viral load monitoring appointments. Undetectable = Untransmittable.

• Being undetectable isn’t a constant state and if you stop taking your medication then your viral load will go back up again.