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When to start treatment

In the UK, standards for HIV treatment and care are set and monitored by the British HIV Association (BHIVA), the professional association for HIV doctors and other healthcare professionals. These standards are reviewed regularly. The most recent guidelines on HIV treatment were updated in 2013.

The guidelines set out the evidence from clinical trials and other research. Taking this into account, along with your own individual circumstances, your doctor will work with you to decide when it is the right time for you to start HIV treatment.

If you do not have any symptoms or HIV-related illness, then the current UK guidelines recommend starting treatment when your CD4 cell count is below or approaching 350 cells/mm3. CD4 cells are a type of immune system cell, and doctors use the number of CD4 cells you have as a marker of the health of your immune system. Clinics use a test that measures the number of CD4 cells in a cubic millimetre of blood. You can find out more about CD4 cell counts in the NAM booklet CD4, viral load & other tests.

In some situations – for example, if you have symptoms, if you have another health condition such as hepatitis or tuberculosis, or to help prevent HIV being passed on during pregnancy, or to a sexual partner – your doctor may recommend you start treatment when your CD4 cell count is still above 350. Studies to determine the best time to start HIV treatment are being carried out.

However a major trial announced its results in May 2015 and this is likely to result in BHIVA's guidelines changing. This study proved that there are advantages to starting treatment at high CD4 cell counts. We now know that starting HIV treatment earlier reduces the risk of serious illnesses, AIDS, death and HIV transmission. 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.

Anti-HIV drugs

Published October 2014

Last reviewed October 2014

Next review October 2017

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

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 It may have been superseded by more recent developments.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.