HIV Treatment

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When to Start Antiretroviral Therapy

Last Reviewed: November 6, 2018

Key Points

  • Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. ART is recommended for everyone who has HIV. ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.
  • People with HIV should start ART as soon as possible. In people with HIV who have 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.)
  • Before starting ART, people with HIV discuss the importance of medication adherence—taking HIV medicines every day and exactly as prescribed—with their health care provider.

When is it time to start taking HIV medicine?

Treatment with HIV medicines (called antiretroviral therapy or ART for short) is recommended for everyone 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 people with HIV who have certain conditions, it's especially important to start ART right away.

What conditions increase the urgency to start ART?

The following conditions increase the urgency to start ART:

  • 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.

All pregnant women with HIV should start taking HIV medicines as soon as possible during pregnancy. In general, women who are already taking HIV medicines when they become pregnant should continue taking HIV medicines throughout their pregnancies. When HIV infection is diagnosed during pregnancy, ART should be started 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
  • Illness with an AIDS-defining condition. AIDS-defining conditions are infections and cancers that are life-threatening in people with HIV. Certain forms of lymphoma and tuberculosis are examples of AIDS-defining conditions.

HIV-related illnesses and coinfections
Some illnesses that develop in people with HIV increase the urgency to start 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. Coinfection with HIV and certain other infections, such as hepatitis B or hepatitis C virus infection, increases the urgency to start ART.

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

ART is an important part of staying healthy with HIV. Studies suggest that these benefits begin even when ART is started during early HIV infection. In addition, starting ART during early HIV infection reduces the risk of HIV transmission.

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

Before starting ART, people with HIV discuss the importance of medication adherence—taking HIV medicines every day and exactly as prescribed—with their health care provider. 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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