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Avoiding HIV Complications: When Should You Start HIV Treatment?

Decreasing the risk of HIV complications and staying healthy with HIV depends partly on starting treatment in a timely way. But what is considered “timely” has changed over time. Treatment was once started when a person’s CD4 count was under 200. Then it changed to under 350.

Now the recommendation is to start treatment if the CD4 count is less than 500. That may be due in part because the lower the CD4 count goes, the more difficult it is to rebuild the immune system. In fact, many large studies have shown that delaying treatment greatly increases the risk of death over the long term, Taifo says.

For some people, treatment is recommended no matter the CD4 count. This includes pregnant women and people who:

  • Have signs of kidney disease, hepatitis B or C co-infection, or many risk factors for heart disease
  • Have a viral load more than 100,000 or a CD4 count that's dropping very fast
  • Have any signs of AIDS
  • Are in relationships with partners who are HIV-negative
  • Are 60 or older

Healthy Living With HIV: Talk to Your Doctor

When you first start on an HIV medication regimen, communication with your doctor is critical -- especially within the first six weeks. "Our job is to educate patients before taking medications and to look out for problems that can be permanent and prevent those that can escalate,” Taiwo says.

Ask your doctor what to expect in terms of side effects and know which ones are likely to subside during the first few weeks. Make sure you have all your providers’ numbers, including after-hours, and know exactly what to do if you run into a problem.

"Some side effects will go away, so try to have a little bit of patience after talking with your provider," Gandhi says. Reassure yourself that these are not dangerous side effects that require a switch or discontinuation of therapy. And when they’re over, you’ll probably only need to check in with your doctor about every three months.

"As long as there is good communication, we can usually help people get through that initial discomfort," Gandhi says. "The most important thing is that there is a line of communication so the patient is not at risk of stopping therapy without checking in about how to make things more comfortable."

Even a potentially life-threatening problem such as immune reconstitution inflammatory syndrome (IRIS) doesn't necessarily require a switch in regimens. That's because it tends to go away by itself. IRIS occurs at the beginning of treatment when the immune system suddenly becomes more active. This can make symptoms of pre-existing conditions temporarily much worse. If it is too severe, steroids may be needed. Again, close communication with your doctor can help sort out which side effects are signs of more serious complications.

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