The most effective treatment for HIV is highly active antiretroviral therapy (HAART)-a combination of several antiretroviral medicines that aims to control the amount of virus in your body. Other steps you can take include keeping your immune system strong, taking medicines as prescribed, and monitoring your CD4+ (white blood cells) counts to slow the multiplication of the virus in your body. If HIV is not treated, it eventually progresses to AIDS, the last and most severe form of HIV. People with AIDS are more likely to develop certain illnesses, called opportunistic infections. Examples include tuberculosis and some cancers. These illnesses are common in people who have weakened immune systems.

Initial treatment

If you are diagnosed with HIV infection during the initial symptoms of early HIV (acute retroviral syndrome), discuss the use of highly active antiretroviral therapy (HAART) with your doctor. Information about treatment of early HIV from clinical trials is very limited but suggests that treatment of early HIV with antiretroviral medicines can increase CD4+ cell counts and decrease viral load.⁴

HAART medicines that are most often used to treat HIV infection include:

• Nucleoside/nucleotide reverse transcriptase inhibitors, such as zidovudine (ZDV, formerly AZT) and stavudine (d4T). These medicines are often combined with other medicines for best results.
• Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz, nevirapine, or delavirdine.
• Protease inhibitors (PIs), such as atazanavir, saquinavir, ritonavir, indinavir, nelfinavir, fosamprenavir, lopinavir/ritonavir, tipranavir, or darunavir.
• Fusion inhibitors, such as enfuvirtide.

Other medicines that may be used to treat HIV or AIDS-related conditions include cytokines, such as interferon alfa-2a and interferon alfa-2b.

The decision whether to start HAART before your health starts to decline is complicated. Consider the potential benefits and risks of early treatment and discuss all the issues with your doctor before starting HAART.

• Benefits. Early treatment of HIV may:⁴
  • Decrease the severity of early HIV symptoms.
  • Affect the rate at which the disease progresses.
  • Reduce the rate at which the virus multiplies in the body.
  • Preserve immune system function.
  • Lower the risk of drug resistance with complete viral suppression.
  • Reduce the risk of HIV spreading.

    Note:

    Even with early treatment, the risk of HIV transmission still exists. Antiretroviral therapy cannot substitute for prevention measures, such as condom use and safer sex practices.
• Risks. Early treatment of HIV may:⁴
  • Cost a lot and cause side effects.
  • Lead to the development of drug resistance to antiretroviral medicines, which may limit future treatment options.
  • Result in the need for continuing therapy indefinitely.
  • Reduce future medication options when HIV disease risk is highest.

If you do not have symptoms of HIV even though you have tested positive for the virus, you and your doctor may simply continue to watch for symptoms to occur. If you do not show any signs of disease and your CD4+ cell count is more than 350 cells per microliter (mcL), you may not require treatment. But during this time you still need regular checkups with a health professional to monitor your viral load and CD4+ cell counts-these tests measure the amount of HIV in your blood and detect how well your immune system is working. For more information, see:

Should I start antiretroviral medicines for HIV infection even though I have no symptoms?

Ongoing treatment