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HIV: When Should I Start Taking Antiretroviral Medicines for HIV Infection?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

HIV: When Should I Start Taking Antiretroviral Medicines for HIV Infection?

Get the facts

Your options

  • Start antiretroviral medicines as soon as you find out that you have HIV.
  • Don't start medicines as soon as you learn that you have HIV. Have regular blood tests to check your levels of HIV and your CD4+ cell count.

Key points to remember

  • When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can help keep your immune system healthy and help you live longer.
  • Medical experts recommend that people begin treatment for HIV as soon as they know they are infected, especially pregnant women and people who have or are at risk for other health problems (such as hepatitis B).1, 2
  • You may decide not to start treatment right away, especially if your CD4+ count is greater than 500.
  • You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
  • These medicines can have serious side effects. Some people do not have side effects or are not bothered by them. Other people may need to change their medicines because of the side effects.
  • If you're pregnant, medicines can help keep your developing baby from getting HIV.
  • Whether or not you start treatment, you'll need to have regular blood tests to check your levels of HIV and your CD4+ cell count.
FAQs

What is HIV?

HIV stands for human immunodeficiency virus. Most people get HIV when they have unprotected sex or share needles with someone who has the virus.

The virus attacks and weakens your immune system, which is your body's natural defense against infection. HIV infects certain white blood cells called CD4+ cells. If too many of these cells are destroyed or weakened, your immune system is less able to fight infection and disease.

HIV infection can lead to AIDS (acquired immunodeficiency syndrome). People with AIDS have a very low number of CD4+ cells and get infections and some cancers that rarely occur in healthy people. These can be deadly.

If HIV is diagnosed before it becomes AIDS, medicines can help keep your immune system strong and healthy. With treatment, many people with HIV are able to live long and active lives.

What medicines are used to treat HIV?

A combination of three or more antiretroviral medicines, called antiretroviral therapy (ART), is the main treatment for HIV. It can slow the rate at which the virus multiplies, prevent AIDS, and keep your immune system healthy.

The goal of treatment is to reduce the amount of virus in your body so that it can no longer be detected in your blood.

There are several medicines that are most often combined to treat HIV. They are sorted into five groups:

  • Nucleoside/nucleotide reverse transcriptase inhibitors, such as tenofovir, emtricitabine, and abacavir
  • Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz, nevirapine, and etravirine
  • Protease inhibitors (PIs), such as atazanavir, ritonavir, and darunavir
  • Entry inhibitors, such as enfuvirtide and maraviroc
  • Integrase inhibitors, such as raltegravir

The U.S. National Institutes of Health recommend one of the following programs for people who begin treatment for HIV:3

  • Efavirenz + tenofovir + emtricitabine
  • Ritonavir-boosted atazanavir + tenofovir + emtricitabine
  • Ritonavir-boosted darunavir + tenofovir + emtricitabine
  • Raltegravir + tenofovir + emtricitabine

You can now get some of these medicines combined into one pill. So you may take 1 to 4 pills a day. Medicines can help stabilize and increase the number of CD4+ cells in your body. And they can prevent AIDS.

How well do these medicines work?

Antiretroviral therapy doesn't cure HIV. But people who take these medicines as prescribed:

  • Avoid getting AIDS, or recover from the symptoms of AIDS and return to better health.
  • Develop fewer conditions, such as pneumonia and certain types of cancers, which are common in people whose immune systems are weak. These are called opportunistic infections.
  • See a major drop in the amount of virus in their body, often to a level where it can no longer be detected in their blood.
  • Have a stable or increasing CD4+ cell count.
  • Are less likely to spread HIV to a sexual partner.

For the medicine to work, you need to take it every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.

What are the side effects of antiretroviral medicines?

Antiretroviral medicines can have side effects that are sometimes serious. If you have side effects, talk to your doctor about ways to reduce them. You may be able to change the way you take the medicines or change to other medicines that have fewer side effects for you. Most people can find an HIV treatment combination that works for them. Be sure you keep taking your medicines, because they help keep the virus under control and your immune system healthy.

If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.

Some side effects, such as nausea, may improve when your body adjusts to the medicines. If you have problems taking your medicines, talk with your doctor. There are medicines you can take to treat the side effects.

Side effects of some antiretroviral medicines may include:

  • Nausea and vomiting.
  • Diarrhea.
  • Fever.
  • Fatigue.
  • Headache.
  • Dizziness.
  • Belly pain.
  • Trouble sleeping.

Certain antiretroviral medicines may also cause more serious medical problems, such as a buildup of acid in your blood, and changes in the way your body stores fat and uses sugar.

Why might your doctor recommend starting antiretroviral medicines?

The U.S. National Institutes of Health (NIH) recommends that people begin treatment for HIV as soon as they know they are infected, especially pregnant women and people who have or are at risk for other health problems (such as hepatitis B).1

  • Treatment for HIV can help keep your immune system healthy and prevent AIDS.
  • Pregnant women with HIV who take antiretroviral medicines help prevent their developing babies from getting HIV.
  • People with HIV who are being treated for the infection are less likely to spread the infection to a sexual partner.3, 4

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Start antiretroviral medicines Start antiretroviral medicines
  • You take pills every day from now on.
  • You have blood tests every few months to check your levels of HIV and your CD4+ cell count.
  • Antiretroviral medicines can:
    • Prevent AIDS.
    • Make your symptoms less severe.
    • Keep your immune system healthy and prevent serious infections and some types of cancers.
    • Reduce your chance of spreading HIV to others.
    • Extend your life.
  • Possible side effects include:
    • Nausea and vomiting.
    • Diarrhea.
    • Fever.
    • Fatigue.
    • Headache.
    • Dizziness.
    • Belly pain.
    • Trouble sleeping.
  • More serious problems may include a buildup of acid in your blood and changes in the way your body stores fat and uses sugar.
  • If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
  • The medicines may cost a lot.
Don't start antiretroviral medicines Don't start antiretroviral medicines
  • You have blood tests every few months to check your levels of HIV and your CD4+ cell count.
  • You don't have to take pills every day.
  • You avoid the side effects and cost of the medicines.
  • If HIV is not treated early, you may be more likely to:
    • Spread HIV to others.
    • Get serious infections, some types of cancers, and AIDS. And you may die from these diseases sooner.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about starting antiretroviral medicine

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I just found out I have HIV. I was really shocked. My doctor said that starting treatment now may help me stay healthy longer. I'm still worried about taking medicine every day, but these medicines sound like my best hope of living so I can see my daughter grow up and get married.

Marla, age 30

I put off taking medicine for HIV for as long as I could, but when my CD4+ cell count dropped to 500, I decided that it was time to start. The medicines made me feel dizzy and sick at the beginning, but they are helping my immune system get stronger. I am feeling a little better every week.

Ted, age 45

I know several people who were feeling just fine but started ART and got really sick. Right now, I'm not ready to start taking medicines every single day. I haven't ruled out taking them later on, but for now I'm going to do the best I can to stay healthy and appreciate every day that I'm not sick.

Greg, age 38

When the doctor first told me I had HIV, I was pretty low. But I know that the newer medicines have fewer side effects than the older ones, and people are getting treated earlier and earlier. My health is important to me. Taking the medicines can help me stay healthy and may help keep my partner from getting HIV.

Miguel, age 40

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antiretroviral medicines

Reasons not to take antiretroviral medicines

I want to do everything I can to avoid getting AIDS and to live a long and healthy life.

I don't want to start taking medicine until I have to.

More important
Equally important
More important

I'm worried that I might spread HIV to others if I don't treat the infection.

I'm not worried about spreading HIV to others.

More important
Equally important
More important

I'm not worried about the side effects of treatment.

I don't think I could handle the side effects of treatment.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antiretroviral medicines

NOT taking antiretroviral medicines

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Even though I don't have symptoms of HIV, I may still need to take medicine.

  • TrueThat's right. Experts recommend starting treatment as soon as you know that you have HIV, especially if you are pregnant or you have or are at risk for other health problems.
  • FalseSorry, that's not right. Experts recommend starting treatment as soon as you know that you have HIV, especially if you are pregnant or you have or are at risk for other health problems.
  • I'm not sureIt may help to go back and read "Get the Facts." Experts recommend starting treatment as soon as you know that you have HIV, especially if you are pregnant or have other health problems.
2.

Antiretroviral medicines can help me stay healthy and prevent AIDS.

  • TrueThat's right. When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.
  • FalseSorry, that's not right. When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.
  • I'm not sureIt may help to go back and read "Get the Facts." When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.
3.

For the medicine to work, I need to take medicine every day.

  • TrueThat's right. You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
  • FalseSorry, that's not right. You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
  • I'm not sureIt may help to go back and read "Get the Facts." You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become harder to treat.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Peter Shalit, MD, PhD - Internal Medicine

References
Citations
  1. U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2012). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf.
  2. Thompson MA, et al. (2012). Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society—USA Panel. JAMA, 308(4): 387–402.
  3. U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2011). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
  4. Cohen MS, et al. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, July 18, epub ahead of print (doi:10.1056/NEJMoa1105243).
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

HIV: When Should I Start Taking Antiretroviral Medicines for HIV Infection?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Start antiretroviral medicines as soon as you find out that you have HIV.
  • Don't start medicines as soon as you learn that you have HIV. Have regular blood tests to check your levels of HIV and your CD4+ cell count.

Key points to remember

  • When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can help keep your immune system healthy and help you live longer.
  • Medical experts recommend that people begin treatment for HIV as soon as they know they are infected, especially pregnant women and people who have or are at risk for other health problems (such as hepatitis B).1, 2
  • You may decide not to start treatment right away, especially if your CD4+ count is greater than 500.
  • You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
  • These medicines can have serious side effects. Some people do not have side effects or are not bothered by them. Other people may need to change their medicines because of the side effects.
  • If you're pregnant, medicines can help keep your developing baby from getting HIV.
  • Whether or not you start treatment, you'll need to have regular blood tests to check your levels of HIV and your CD4+ cell count.
FAQs

What is HIV?

HIV stands for human immunodeficiency virus. Most people get HIV when they have unprotected sex or share needles with someone who has the virus.

The virus attacks and weakens your immune system, which is your body's natural defense against infection. HIV infects certain white blood cells called CD4+ cells. If too many of these cells are destroyed or weakened, your immune system is less able to fight infection and disease.

HIV infection can lead to AIDS (acquired immunodeficiency syndrome). People with AIDS have a very low number of CD4+ cells and get infections and some cancers that rarely occur in healthy people. These can be deadly.

If HIV is diagnosed before it becomes AIDS, medicines can help keep your immune system strong and healthy. With treatment, many people with HIV are able to live long and active lives.

What medicines are used to treat HIV?

A combination of three or more antiretroviral medicines, called antiretroviral therapy (ART), is the main treatment for HIV. It can slow the rate at which the virus multiplies, prevent AIDS, and keep your immune system healthy.

The goal of treatment is to reduce the amount of virus in your body so that it can no longer be detected in your blood.

There are several medicines that are most often combined to treat HIV. They are sorted into five groups:

  • Nucleoside/nucleotide reverse transcriptase inhibitors, such as tenofovir, emtricitabine, and abacavir
  • Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz, nevirapine, and etravirine
  • Protease inhibitors (PIs), such as atazanavir, ritonavir, and darunavir
  • Entry inhibitors, such as enfuvirtide and maraviroc
  • Integrase inhibitors, such as raltegravir

The U.S. National Institutes of Health recommend one of the following programs for people who begin treatment for HIV:3

  • Efavirenz + tenofovir + emtricitabine
  • Ritonavir-boosted atazanavir + tenofovir + emtricitabine
  • Ritonavir-boosted darunavir + tenofovir + emtricitabine
  • Raltegravir + tenofovir + emtricitabine

You can now get some of these medicines combined into one pill. So you may take 1 to 4 pills a day. Medicines can help stabilize and increase the number of CD4+ cells in your body. And they can prevent AIDS.

How well do these medicines work?

Antiretroviral therapy doesn't cure HIV. But people who take these medicines as prescribed:

  • Avoid getting AIDS, or recover from the symptoms of AIDS and return to better health.
  • Develop fewer conditions, such as pneumonia and certain types of cancers, which are common in people whose immune systems are weak. These are called opportunistic infections.
  • See a major drop in the amount of virus in their body, often to a level where it can no longer be detected in their blood.
  • Have a stable or increasing CD4+ cell count.
  • Are less likely to spread HIV to a sexual partner.

For the medicine to work, you need to take it every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.

What are the side effects of antiretroviral medicines?

Antiretroviral medicines can have side effects that are sometimes serious. If you have side effects, talk to your doctor about ways to reduce them. You may be able to change the way you take the medicines or change to other medicines that have fewer side effects for you. Most people can find an HIV treatment combination that works for them. Be sure you keep taking your medicines, because they help keep the virus under control and your immune system healthy.

If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.

Some side effects, such as nausea, may improve when your body adjusts to the medicines. If you have problems taking your medicines, talk with your doctor. There are medicines you can take to treat the side effects.

Side effects of some antiretroviral medicines may include:

  • Nausea and vomiting.
  • Diarrhea.
  • Fever.
  • Fatigue.
  • Headache.
  • Dizziness.
  • Belly pain.
  • Trouble sleeping.

Certain antiretroviral medicines may also cause more serious medical problems, such as a buildup of acid in your blood, and changes in the way your body stores fat and uses sugar.

Why might your doctor recommend starting antiretroviral medicines?

The U.S. National Institutes of Health (NIH) recommends that people begin treatment for HIV as soon as they know they are infected, especially pregnant women and people who have or are at risk for other health problems (such as hepatitis B).1

  • Treatment for HIV can help keep your immune system healthy and prevent AIDS.
  • Pregnant women with HIV who take antiretroviral medicines help prevent their developing babies from getting HIV.
  • People with HIV who are being treated for the infection are less likely to spread the infection to a sexual partner.3, 4

2. Compare your options

  Start antiretroviral medicines Don't start antiretroviral medicines
What is usually involved?
  • You take pills every day from now on.
  • You have blood tests every few months to check your levels of HIV and your CD4+ cell count.
  • You have blood tests every few months to check your levels of HIV and your CD4+ cell count.
What are the benefits?
  • Antiretroviral medicines can:
    • Prevent AIDS.
    • Make your symptoms less severe.
    • Keep your immune system healthy and prevent serious infections and some types of cancers.
    • Reduce your chance of spreading HIV to others.
    • Extend your life.
  • You don't have to take pills every day.
  • You avoid the side effects and cost of the medicines.
What are the risks and side effects?
  • Possible side effects include:
    • Nausea and vomiting.
    • Diarrhea.
    • Fever.
    • Fatigue.
    • Headache.
    • Dizziness.
    • Belly pain.
    • Trouble sleeping.
  • More serious problems may include a buildup of acid in your blood and changes in the way your body stores fat and uses sugar.
  • If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.
  • The medicines may cost a lot.
  • If HIV is not treated early, you may be more likely to:
    • Spread HIV to others.
    • Get serious infections, some types of cancers, and AIDS. And you may die from these diseases sooner.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about starting antiretroviral medicine

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I just found out I have HIV. I was really shocked. My doctor said that starting treatment now may help me stay healthy longer. I'm still worried about taking medicine every day, but these medicines sound like my best hope of living so I can see my daughter grow up and get married."

— Marla, age 30

"I put off taking medicine for HIV for as long as I could, but when my CD4+ cell count dropped to 500, I decided that it was time to start. The medicines made me feel dizzy and sick at the beginning, but they are helping my immune system get stronger. I am feeling a little better every week."

— Ted, age 45

"I know several people who were feeling just fine but started ART and got really sick. Right now, I'm not ready to start taking medicines every single day. I haven't ruled out taking them later on, but for now I'm going to do the best I can to stay healthy and appreciate every day that I'm not sick."

— Greg, age 38

"When the doctor first told me I had HIV, I was pretty low. But I know that the newer medicines have fewer side effects than the older ones, and people are getting treated earlier and earlier. My health is important to me. Taking the medicines can help me stay healthy and may help keep my partner from getting HIV."

— Miguel, age 40

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antiretroviral medicines

Reasons not to take antiretroviral medicines

I want to do everything I can to avoid getting AIDS and to live a long and healthy life.

I don't want to start taking medicine until I have to.

More important
Equally important
More important

I'm worried that I might spread HIV to others if I don't treat the infection.

I'm not worried about spreading HIV to others.

More important
Equally important
More important

I'm not worried about the side effects of treatment.

I don't think I could handle the side effects of treatment.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antiretroviral medicines

NOT taking antiretroviral medicines

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Even though I don't have symptoms of HIV, I may still need to take medicine.

  • True
  • False
  • I'm not sure
That's right. Experts recommend starting treatment as soon as you know that you have HIV, especially if you are pregnant or you have or are at risk for other health problems.

2. Antiretroviral medicines can help me stay healthy and prevent AIDS.

  • True
  • False
  • I'm not sure
That's right. When taken as prescribed, antiretroviral medicines can prevent AIDS. And they can keep your immune system healthy and help you live longer.

3. For the medicine to work, I need to take medicine every day.

  • True
  • False
  • I'm not sure
That's right. You need to take medicine every day. If you can't take your medicine as prescribed and you miss doses, HIV may become resistant to the medicine and harder to treat.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Peter Shalit, MD, PhD - Internal Medicine

References
Citations
  1. U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2012). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf.
  2. Thompson MA, et al. (2012). Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society—USA Panel. JAMA, 308(4): 387–402.
  3. U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2011). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
  4. Cohen MS, et al. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, July 18, epub ahead of print (doi:10.1056/NEJMoa1105243).

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