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HIV AIDS - HIV and Aids Medication Guide
Written by Aidsmap   
Monday, 15 May 2006
It’s not known for certain what is the best time to start treatment with anti-HIV drugs. This means you need to weigh up with your doctor, on an individual basis, the likely benefits and risks of starting treatment now as opposed to waiting until later.

However, it’s currently recommended in UK HIV treatment guidelines that you start anti-HIV treatments immediately if you are ill because of HIV, or have an AIDS-defining illness. It’s also recommended that you start treatment if your CD4 cell count is near or below 200, the level at which you become vulnerable to serious AIDS-defining illnesses, or is falling very rapidly.

UK treatment guidelines also make other recommendations about whether you should take HIV treatments, depending on the length of time you have been infected with HIV, the level of your CD4 cell count and the amount of HIV in your blood – your viral load.


Recently infected with HIV?
The six months after you are infected by HIV is called primary HIV infection. There is no proof that taking treatment at this time will mean that you live a longer, healthier life. Some doctors believe, however, that treatment at this time may offer a unique chance to control HIV which may be lost later, as your immune system sustains ongoing damage due to HIV, and becomes less able to attack HIV. Whatever your CD4 cell count, if you are considering treatment soon after infection, you should start as soon as possible, and certainly within six months of infection with HIV. Clinical trials are underway to assess the effectiveness of taking anti-HIV treatment at this stage and you might wish to consider joining one.

The potential benefits of taking treatment at this time need to be weighed up against the risk of side-effects. Treatments may reduce your quality of life at a time when HIV would not have. There is also a possibility that if your treatments don’t work effectively against HIV, drug resistance could develop, and you would have fewer drug options if you became ill because of HIV.

A very small number of people become really quite ill during primary infection with HIV, and might even need to be admitted to hospital. Taking anti-HIV treatment at this stage may be particularly beneficial in these circumstances. But it’s not clear how long you’ll need to take treatment for – current practice is to treat for six months to a year – and you might experience symptoms again once you stop your treatment.


Infected with HIV for over six months, but without symptoms?
Ideally, you should begin treatment before your CD4 count falls below 200. This is because if you start treatment when your CD4 count is below 200, you face a greater risk of ill health and even death, in the short-term, than if you start while your CD4 count is still above 200.

At higher CD4 counts, the picture is less clear. Most studies suggest that there seems to be no difference in the short-term risk of ill health if you begin treatment at CD4 counts above the 200 level. Therefore, the timing in these circumstances will depend on the level of your viral load, the speed at which your CD4 count is falling, the likelihood of you achieving good adherence to treatment, the presence of symptoms, the presence of hepatitis C virus coinfection and your wishes.

You may choose an earlier start, particularly if your CD4 count is falling by more than 80 cells per year, because this is likely to mean that the count will fall below 200 within the near future. Similarly, if you have a high viral load, and are not taking treatment, then you lose CD4 cells more quickly than others, and are at greater risk of illness or death in the short-term, and you may, therefore, choose to start treatment sooner.

You may wish to consider starting treatment earlier if you are also infected with hepatitis C virus, as liver disease becomes worse when the CD4 cell count is lower. There's a lot more information on hepatitis C in the section 'Illness in the age of anti-HIV treatment - hepatitis.'

Delaying therapy reduces the impact of long-term side-effects and the development of drug resistance. Therapies of the future may be easier to take, less toxic and perhaps more effective against HIV. The best responses to anti-HIV treatment are generally seen with the first drug combination, so starting too early, or with the wrong drug combination may not be the best option.

If you are advised to start treatment but choose not to, then you should review your decision regularly and have your CD4 count and viral load monitored more frequently than usually recommended, for example every two months.

Infected with HIV for over six months, and ill because of HIV?
Regardless of your CD4 cell count, doctors recommend that you should take anti-HIV treatments if you are becoming ill because of HIV.

A possible exception, however, would be if you have tuberculosis. There are potential interactions between anti-HIV drugs and a key medicine used to treat tuberculosis. Because of this, many doctors recommend delaying treatment with anti-HIV drugs until a person has taken at least two months of tuberculosis treatment. Similarly, if you become ill with tuberculosis whilst taking HAART, you may be recommended to stop taking anti-HIV drugs for the first two months of tuberculosis treatment.

If your CD4 cell count is below 200 you should start anti-HIV treatment immediately.

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Last Updated ( Monday, 15 May 2006 )
 
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