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When to start treatment

Treatment guidelines give a broad indication of when to start HIV treatment. However, there may be reasons why someone starts at a different time to others. Your doctor will discuss a range of issues with you, before working with you to decide when you should start. This will include weighing up the likely benefits and risks for you of starting treatment as opposed to waiting until later.

It is recommended in the UK HIV treatment guidelines that you start taking HIV treatment immediately if you are ill because of HIV, or if you have an AIDS-defining illness.

If you do not have any symptoms, then these guidelines recommend that you start treatment when your CD4 cell count is around 350. Clinics use a test called a CD4 cell count that measures the number of CD4 cells in a cubic millimetre of blood. CD4 cells are a type of immune system cell, and doctors use your CD4 cell count as a marker of the health of your immune system. CD4 cell counts in HIV-negative people range from about 500 to 1500. You can find out more about CD4 cell counts in NAM’s booklet CD4, viral load & other tests.

Your doctor should start discussing HIV treatment with you before your CD4 cell count starts approaching 350. Once your CD4 cell count is around 350, you are advised to start treatment as soon as you are ready.

In some situations – for example, if you have another health condition such as hepatitis, kidney or heart disease – your doctor may recommend you start treatment sooner, when your CD4 cell count falls below 500 (or, in some situations, even higher).

There is now good evidence that, if someone is on HIV treatment and has an undetectable viral load, there is a very low risk of passing on HIV. If you decide you would like to start HIV treatment to reduce the risk of transmission to partners, talk to your doctor about this. You can start treatment at any CD4 cell count for the purposes of prevention of HIV transmission to sexual partners.

Studies to determine the best time to start HIV treatment are being carried out. Your doctor may ask you if you want to participate in a clinical trial. Clinical trials for people starting HIV treatment may look at the best time to start HIV treatment, or compare different combinations of anti-HIV drugs. You can find out more about taking part in a clinical trial in NAM’s factsheets at www.aidsmap.com/factsheets.

Starting HIV treatment with a low CD4 cell count

If your CD4 cell count is under 350 when you are diagnosed with HIV, you will be encouraged to start treatment soon. Your doctor is likely to suggest starting treatment immediately if your CD4 cell count is under 200, as you are at risk of some serious illnesses.

Modern HIV treatment is highly effective. Most people who start HIV treatment when their CD4 cell count is already low (200 or under) will see it start to climb after starting treatment. Long-term HIV therapy can result in your CD4 count returning to the normal level for someone of your age.

However, if possible, it is better to start treatment before your CD4 count drops this low. It can be harder to bring your CD4 count back up to a normal level for your age if it has been very low at one time.

You can find out more about starting treatment when your CD4 cell count is low in NAM’s factsheet: Diagnosed with HIV at a low CD4 count 

The importance of regular check-ups

If you have HIV, you should see a doctor regularly for a check-up. How often this is will depend on a number of factors, including whether you are on HIV treatment and how it is working, and your general health.

Most people with HIV attend sexual health clinics or other specialist HIV clinics, which have doctors and other health professionals trained in HIV care. Even if you do not need to start HIV treatment at this stage, regular blood tests will tell you about the health of your immune system and indicate when you should think about starting. Regular discussions with your healthcare team will identify if you have other reasons to consider starting treatment. 

In England, all HIV care and the anti-HIV drugs provided through NHS HIV clinics and sexual health clinics are free (including no prescription charge), whatever someone’s immigration status is. 

In Scotland, Wales and Northern Ireland, people are not normally charged for HIV treatment and care, although the law still says they can be if they are of uncertain immigration status. An HIV support organisation can help you if you are concerned about being charged for treatment. You can look for support organisations in NAM’s online directory, the e-atlas (www.aidsmap.com/e-atlas).

Taking your HIV treatment

Published March 2014

Last reviewed March 2014

Next review March 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.