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HIV Treatment

When to Start Antiretroviral Therapy

(Last updated 2/24/2016; last reviewed 2/24/2016)

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Key Points

  • Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. ART is recommended for everyone infected with HIV. ART helps people with HIV live longer, healthier lives.
  • People with HIV should begin ART as soon as possible. In HIV-infected people with the following conditions, it’s especially important to start ART right away: pregnancy, AIDS, certain HIV-related illnesses and coinfections, and early HIV infection. (Early HIV infection is the period up to 6 months after infection with HIV.)
  • Effective ART depends on medication adherence—taking HIV medicines every day and exactly as prescribed. Before starting ART, it’s important to address any issues that can make adherence difficult.

When is it time to start taking HIV medicine?

Treatment with HIV medicines (called antiretroviral therapy or ART for short) is recommended for everyone infected with HIV. ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.

The Department of Health and Human Services (HHS) guidelines on the use of HIV medicines in adults and adolescents recommend that people with HIV start ART as soon as possible. In HIV-infected people with certain conditions, it’s especially important to start ART right away.

What conditions increase the need to start ART?

HIV-infected people with the following conditions should consider starting ART immediately: 

  • Pregnancy
  • AIDS
  • Certain HIV-related illnesses and coinfections
  • Early HIV infection

Pregnancy
All pregnant women with HIV should take HIV medicines to prevent mother-to-child transmission of HIV. The HIV medicines will also protect the health of the pregnant woman.

In general, women who are already taking HIV medicines when they become pregnant should continue taking HIV medicines throughout their pregnancies. If HIV infection is diagnosed during pregnancy, the HIV-infected pregnant woman should consider starting ART right away.

AIDS
Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of HIV infection. People with AIDS should start ART immediately.

A diagnosis of AIDS is based on the following criteria:

  • A CD4 count less than 200 cells/mm3. A low CD4 count is a sign that HIV has severely damaged the immune system.
  • OR
  • The presence of an AIDS-defining condition. AIDS-defining conditions are infections and cancers that are life-threatening in people with HIV. Certain forms of cervical cancer and tuberculosis are examples of AIDS-defining conditions.

HIV-related illnesses and coinfections
Some illnesses that develop in people infected with HIV increase the need for ART. These illnesses include HIV-related kidney disease and certain opportunistic infections (OIs). OIs are infections that develop more often or are more severe in people with weakened immune systems, such as people with HIV.

Coinfection is when a person has two or more infections at the same time. People who are infected with HIV and certain other infections, such as hepatitis B or hepatitis C virus infection, should consider starting ART immediately.

Early HIV infection
The period up to 6 months after infection with HIV is called early HIV infection. During early HIV infection, the level of HIV in the body (called viral load) is very high. A high viral load damages the immune system and increases the risk of HIV transmission. 

Studies suggest that even in early HIV infection, ART can improve health and prolong life. In addition, ART started during early HIV infection reduces the risk of HIV transmission. For these reasons, people with early HIV infection should consider starting ART immediately.

Once a person starts ART, why is medication adherence important?

ART is a life-long treatment that helps people with HIV live longer, healthier lives. But effective ART depends on medication adherence—taking HIV medicines every day and exactly as prescribed. Adherence to an HIV regimen prevents HIV from multiplying and destroying the immune system. Taking HIV medicines every day also reduces the risk of HIV transmission.

Before starting ART, it’s important to address issues that can make adherence difficult. For example, a busy schedule or lack of health insurance to cover the cost of HIV medicines can make it hard to take HIV medicines consistently. Health care providers can recommend resources to help people deal with any issues that may interfere with adherence.

Read the following AIDSinfo fact sheets to learn more about medication adherence:

This fact sheet is based on information from the following sources:

From the U.S. Department of Health and Human Services:

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