Arguments in favour of early treatment

• The earlier you start, the less damage will have been done to your immune system.

• Current drugs probably have a greater chance of getting your viral load down to undetectable levels if you start when viral load is relatively low (below 50,000 copies).

• Starting treatment at a higher CD4 cell count reduces the risk of a big decline in your CD4 cell count if you decide to stop treatment later. Most people who stop treatment experience a fall in their CD4 cell count back to its pre-treatment level within six months of stopping treatment.

Arguments against early treatment

• The health benefits of early treatment have not been proven - it's a theory. There is new evidence that starting treatment early (viral load below 50,000 or CD4 count above 350) has no benefit in terms of delaying illness compared to starting a bit later (e.g. CD4 200-350 and viral load between 50,000 and 100,000 copies), at least in the short term (one to two years). Longer term follow-up is not yet available.

• We don't know how long the drugs may have to be taken for. The current view is that they must be taken for as long as you live.

• Long-term side effects may lower quality of life. Known long-term side effects of treatment include: metabolic disorders which may be associated with increased risk of heart disease and diabetes; body fat changes and wasting; pancreatitis and liver failure; and severe nerve pain known as peripheral neuropathy

• You could develop resistance if the treatment fails, and then you may be cross-resistant to many of the drugs now available.

• Better drugs which are easier to take might be available in a few years time.

Treatment in primary infection

• Primary infection is the period just after infection with HIV. It is often marked by a flu-like illness.

• Some researchers think that treatment around this time will reduce the risk of developing AIDS, or might even get rid of the virus. However, no long-term clinical studies have proved this theory.

Planning for the future

• Decisions about starting treatment need to include decisions about the order in which you take drugs. This means taking into account what you will do if the first combination of drugs fails. Will you have developed cross-resistance to lots of other useful drugs if you develop resistance to your first drug combination? For example, you may be cross-resistant to all other protease inhibitors if you include a protease inhibitor in your first combination and this fails.

• See Choosing a combination for further information on the range of drugs and current thinking about the sequence in which they could be used.