The Big Treatment Questions

So on to the first big question—when to start treatment. Since useful drugs have become available, many doctors have gotten very excited about HIV treatment, and they often recommend that treatment begin as soon as possible. This may be the right option for you, but it’s usually worth taking your time to learn about the drugs before you make a decision about starting treatment. Sometimes HIV-positive people can be healthy and stable for a long time without medication. In the US government’s guidelines on HIV-treatment, the most important instruction about starting treatment is often overlooked: treatment should begin when you are ready.

Introduction

Deciding when to start HIV treatment—and figuring out which drugs to start with—is, perhaps, one of the most difficult decisions you will need to make. And, depending on which way you look at it, the fact that everyone has different opinions regarding these issues can be either helpful, frustrating, or a combination of both.

Learning all you can about the pros and cons of your various treatment options is your best weapon in the fight against HIV. The following questions & answers (Q&A) are intended to provide you with the necessary information you need to communicate effectively with your doctor as you discuss these options.

Why is treatment necessary?

If HIV is allowed to reproduce, or “replicate,” inside the body, it will cause damage to the immune system. Ultimately, the immune system gets so weak that the body becomes vulnerable to other diseases. This is the point at which a person is usually diagnosed with full-blown AIDS, and the other diseases they get can eventually cause death. For adults who live in wealthy nations—such as the United States—the average time between becoming infected with HIV and the development of AIDS is 10 years.

This does not, however, include people who take HIV drugs. Clinical trials—studies in which new and old drugs are tested in humans—have repeatedly shown that HIV drugs can keep HIV-infected people alive longer. Treatment, therefore, is a very important option, and people living with the virus should consider starting treatment before HIV has had a chance to do serious damage to their immune systems.

Why is treatment necessary?

If  HIV is allowed to reproduce, or “replicate,” inside the body, it will cause damage to the immune system. Ultimately, the immune system gets so weak that the body becomes vulnerable to other diseases. This is the point at which a person is usually diagnosed with full-blown AIDS, and the other diseases they get can eventually cause death. For adults who live in wealthy nations—such as the United States—the average time between becoming infected with HIV and the development of AIDS is 10 years.

Why is treatment necessary?

If HIV is allowed to reproduce, or “replicate,” inside the body, it will cause damage to the immune system. Ultimately, the immune system gets so weak that the body becomes vulnerable to other diseases. This is the point at which a person is usually diagnosed with full-blown AIDS, and the other diseases they get can eventually cause death. For adults who live in wealthy nations—such as the United States—the average time between becoming infected with HIV and the development of AIDS is 10 years.

This does not, however, include people who take HIV drugs. Clinical trials—studies in which new and old drugs are tested in humans—have repeatedly shown that HIV drugs can keep HIV-infected people alive longer. Treatment, therefore, is a very important option, and people living with the virus should consider starting treatment before HIV has had a chance to do serious damage to their immune systems.

When will I know that it’s time to start treatment?

There’s really no right or wrong answer—it all depends on the individual. Working closely with your doctor, you can determine when the best time is to start treatment. This will largely depend on two factors: your physical health and your mental readiness to start therapy and stick with it.

In terms of physical health, your CD4 cell count, how you feel and your medical history all play major roles when figuring out when to start HIV treatment.

CD4 cells—also known as T-cells, T-helper cells, or T4-cells—belong to a group of white blood cells called lymphocytes. These cells have the double distinction of not only being the primary target of HIV, but also carry the responsibility of coordinating the way in which the immune system responds to disease-causing infections. When the CD4 cell count—the number of cells in a cubic millimeter or milliliter of blood—drops below 200, the immune system is considered to be “compromised” and you are at a higher risk of experiencing an AIDS-related opportunistic infection, like Pneumocystis pneumonia. In turn, experts suggest that HIV treatment be started before the CD4 count drops below 200; it is generally recommended that antiretroviral therapy be started once the CD4 count falls below 350.