When to Start Treatment

Regular checkups will help your doctor monitor your health. Your checkups will likely include a physical exam and lab tests, such as a CD4 count, viral load test, and may also include a test to see if your HIV strain is resistant to any HIV drugs. This information will help your doctor recommend a time to start treatment and come up with a treatment plan. Generally, you should start treatment if:

  • You have severe symptoms of HIV infection or have been diagnosed with AIDS.
  • Your CD4 count is 350 cells/mm3 or less. Your CD4 count is a measure of your immune system’s strength. Treatment should be started before HIV has done too much damage to your immune system. But starting very early (based on your CD4 count) if you are not sick is not currently advised.
  • You are pregnant. For treatment guidelines for pregnant women with HIV, see the Pregnancy section.
  • You have HIV-related kidney disease.
  • You are being treated for hepatitis B.

Once you begin treatment, you may need to continue taking HIV medicines for the rest of your life. So other factors you will need to consider before starting treatment include:

  • Readiness to stick with treatment. You will need to take all of the drugs exactly how your doctor tells you to, without missing any doses. Missing doses can result in the virus becoming resistant to the medications. Once this happens, the drugs will not work as well or at all. Since one drug isn’t strong enough to fight HIV alone, you will have to take several drugs every day. Whether you must take multiple pills or just a few pills a day, you must be ready to commit to taking all your medicines as directed and stick with it.
  • Managing side effects. You will likely have some side effects from the drugs. Some of these are tougher to live with than others. And some go away over time, while others will stay. Some side effects are more common and more severe in the first few months of treatment. You must be ready and willing to put up with side effects before you begin treatment. Be sure to tell your doctor about any side effects you are having. Many side effects can be managed.

There are still a number of things about treatment of HIV that we do not know. This is particularly true for women. Research and clinical trials of what medicines to use and when to start are seeking to answer those questions.

When you begin to discuss treatment options with your doctor, ask about clinical trials. Your doctor can tell you if there are any that would be open to you and how to enroll if you want to participate.