Day one:
After you've tested positive

May 2008     View PDF     En español

When to start treatment

Getting the earliest possible treatment is generally recommended for treating illnesses. Biologically, there’s little reason to think that HIV is any different. In fact, early treatment may be even more important because of the seriousness of the disease. But just what “early” means in the case of HIV disease is not so clear.

When to start HIV medicines is the subject of a great deal of debate and theory. Some people believe that starting treatment is appropriate immediately upon learning of the infection, whether or not your CD4 count is falling, viral load is high or rising, or whether symptoms are evident. Waiting might only let the infection progress and spread to other parts of the body.

A second argument in favor of early treatment is that this may prevent losing critical cells in your immune system. But since we don’t know exactly when the loss of these cells occurs, it’s still hard to know “when” is the right time to start.

Some researchers prefer to withhold treatment until later in the disease. They believe it is best to save the drugs for later when HIV is more active or when your immune system shows obvious damage. They fear that treating too early may “use up” the medicines before they’re most critically needed. They also fear that people will have long-term side effects from the drugs before they’re truly needed.

Since none of the current drugs can be used indefinitely, this argument cannot be casually dismissed. However, even these researchers believe it’s wise to start before there’s evidence of major damage to the immune system. Just “when” that occurs is unclear. Almost all researchers agree that it’s necessary to start HIV therapy when symptoms are present, your CD4 count is falling, or your viral load is high.

We will get clearer answers to these questions as more studies are completed. In the meantime, the question remains a matter of personal choice. For information about HIV therapy, developing a long-term strategy and making decisions about therapies, call Project Inform’s National HIV/AIDS Treatment Hotline at 1-800-822-7422, or email a question to our operators.