Effective HIV treatment has reduced the risk of developing many serious HIV-related health problems for many people. However, they still occur, and other, non-HIV-related conditions can also develop. Some of these will affect the timing or choice of HIV treatment.
Start HIV treatment straightaway, whatever your CD4 cell count, if you also have:
These are all AIDS-defining illnesses.
Start treatment immediately if you have been diagnosed with an AIDS-defining condition.
If you have a non-AIDS defining cancer, start HIV treatment immediately, especially if you are starting chemotherapy or radiotherapy treatment. This is because these treatments are known to suppress the immune system.
BHIVA emphasises the importance of checking possible drug interactions between anti-HIV drugs and any anti-cancer treatments.
The anti-HIV drug ritonavir (Norvir) interacts with some chemotherapy drugs. This might mean your HIV treatment will be changed to avoid this.
Anti-HIV drugs that cause similar side-effects to chemotherapy drugs should be avoided, as this will increase the chances of these side-effects developing.
HIV-related neurocognitive impairment
Serious HIV-related neurocognitive illnesses (those that affect brain function) are now rare in the UK. Less serious neurocognitive changes are more common, but not everyone will have noticeable symptoms as a result.
If you have an HIV-associated neurocognitive disorder – and you have symptoms as a result – start HIV treatment straightaway, whatever your CD4 cell count.
In this situation, start a standard treatment combination (see What anti-HIV drugs will you start with? in Factsheet 1: Starting treatment).
If you start a standard treatment combination, and your neurocognitive condition doesn’t get better (or gets worse), BHIVA guidelines set out how this situation should be managed. This will include checking to see if your symptoms could be caused by another condition, which may not be related to HIV, and doing more detailed tests to look at HIV present in the cerebrospinal fluid (the fluid around the brain and spine). The results of these tests might help your doctor decide on a new treatment combination.
Chronic kidney disease
If you have kidney disease caused by HIV (also known as HIV-associated nephropathy or HIVAN), start HIV treatment straightaway, whatever your CD4 cell count.
If you have end-stage kidney disease, and would be considered suitable for a kidney transplant, start HIV treatment straightaway, whatever your CD4 cell count.
Anti-HIV drugs that are linked to the risk of kidney damage should be avoided in your treatment combinations if you have moderate or severe kidney disease, if there is a suitable alternative.
Doctors should consider adjusting the dose of any anti-HIV drugs cleared by the kidneys for people with reduced kidney function.
The risk of cardiovascular (heart) disease is increased in people with HIV. There are a number of causes for this, including traditional risk factors such as smoking and the effects of untreated HIV, but some research links it to the side-effects of some anti-HIV drugs.
If you already have cardiovascular disease, or are at high risk for it, avoid abacavir (Ziagen), fosamprenavir (Telzir) boosted with ritonavir, and Kaletra (lopinavir/ritonavir), if acceptable alternative anti-HIV drugs are available.