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Starting HIV treatment

Michael Carter, Greta Hughson
Published: 14 March 2016

Everyone who has diagnosed HIV is recommended to take HIV treatment. It is better for your health to begin HIV treatment sooner, rather than later.

Anti-HIV drugs work by lowering the amount of HIV in the blood (viral load). The aim of HIV treatment is an undetectable viral load. This means that the amount of HIV in a blood sample is so low that it cannot be detected using a standard test. Reducing the amount of HIV in your blood allows your immune system (measured by your CD4 cell count) to strengthen. The higher your CD4 cell count, the lower your risk of becoming ill because of HIV (and possibly some other serious illnesses as well).

You should discuss with your doctor the best time for you to start HIV treatment. There are a number of factors you might want to consider, including:

  • The benefits of starting treatment now.
  • The potential risks if you delay starting treatment.
  • Are you ready to start treatment now?
  • Are there other factors in your life that affect your ability to start taking HIV treatment?

There may be other things which are relevant to your treatment and care and you may have other questions. It's a good idea to take some time to think about these before you go to an appointment at your clinic. To help you prepare for these conversations with your doctor, we have put together an online tool called Talking points. You can find it at www.aidsmap.com/talking-points.

When to start treatment

Until recently, doctors weren’t sure of the best time to start HIV treatment. However in 2015 a large, well-conducted study demonstrated that there are advantages to starting treatment as soon as possible, with high CD4 cell counts. The study clearly demonstrated that starting HIV treatment earlier reduces the risk of serious illnesses, AIDS and death. While people sometimes worry about the side-effects of anti-HIV drugs, the study also showed that people who began HIV treatment earlier had a better quality of life than people who waited.

Other large studies have shown that taking treatment and having an undetectable viral load dramatically reduces the risk of HIV transmission. 

And other research has shown that with HIV treatment many people living with HIV can have a more or less normal lifespan.

Because of this, HIV treatment guidelines, both in the UK and elsewhere in the world, now recommend that all people with HIV should take HIV treatment, regardless of their CD4 count.

If your CD4 cell count is below 200, it is especially important that you begin HIV treatment as soon as possible. The lower your CD4 cell count, the greater the risk of HIV making you ill. But even at higher CD4 cell counts, above 500, treatment you take now will protect your health, both now and in the future.

It’s important to feel ready for the commitment of taking HIV treatment, but when you do feel ready, there’s no reason to delay.

Which anti-HIV drugs to start with

Standard treatment for people starting HIV treatment for the first time is a combination of three different drugs. Anti-HIV drugs belong to different classes depending on the way they work against HIV. The three main classes of anti-HIV drug are nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and ritonavir-boosted protease inhibitors.

The preferred combination of anti-HIV drugs for people taking HIV treatment for the first time is the NNRTI efavirenz (Sustiva) with either the NRTIs tenofovir (Viread) and FTC (emtricitabine, Emtriva) or 3TC (lamivudine, Epivir ) and abacavir (Ziagen). Tenofovir and FTC come in a combined pill called Truvada. 3TC (lamivudine, Epivir ) and abacavir (Ziagen) come in the combination pill Kivexa.

Before taking Kivexa you need to have a blood test to make sure that you are not allergic to abacavir. Kivexa might not be a good choice if you have a risk of heart disease. And tenofovir might not be a good choice if you have kidney problems.

If you're taking efavirenz, tenofovir and FTC, once you’ve had an undetectable viral load for at least six months you may be able to switch and take all three of these drugs in a single combined pill called Atripla.

An alternative to efavirenz is a protease inhibitor boosted with ritonavir. A boosted protease inhibitor could be a good option if your HIV has drug resistance to NNRTIs or NRTIs. The preferred protease inhibitors are lopinavir, atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Telzir) or saquinavir (Invirase). All these protease inhibitors are boosted with a separate dose of ritonavir, except lopinavir, which is only available in a pill combined with ritonavir (Kaletra). 

The integrase inhibitor raltegravir (Isentress) and the CCR5 inhibitor maraviroc (Celsentri) have also been approved for people starting HIV treatment.

If you are thinking about having a baby then nevirapine (Viramune) is recommended. But women are advised not to start taking nevirapine if their CD4 cell count is above 250 because of a risk of serious side-effects. AZT and 3TC (Combivir) are recommended as the other two drugs for women considering pregnancy. These three drugs are recommended during pregnancy because they have been shown to be good at preventing mother-to-baby transmission of HIV.

Contact NAM to find out more about the scientific research and information used to produce this factsheet.

Talking points

Talking points is designed to help you talk to your doctor about HIV treatment.

Go to Talking points >
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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