Starting HIV Treatment
In order to decide whether or not a person living with HIV should start treatment, clinical tests will determine the stage of HIV infection and their readiness for antiretroviral drug (ARV) treatment.
The average person is recommended to start treatment when their CD4 count drops below 500 cells/mm3. This is in line with the most recent World Health Organisation (WHO) Treatment Guidelines which increased the eligibility from under 350 to under 500 cells/mm3.
People who have a CD4 cell count higher than 350 cells/mm3 are typically healthy and do not show any symptoms. Health professionals are concerned that people in this situation will feel complacent about adhering to taking treatment for a virus that is not yet making them ill.
However, many people report the desire to stay healthy, and to reduce the chance of HIV transmissionto others as the main reasons why they are keen to start antiretroviral treatment early. A rural HIV clinic in Uganda found that between 95 and 98 percent of their patients with a CD4 cell count above 350 cells/mm3 achieved excellent adherence and viral suppression within 48 months.
Starting treatment early significantly reduces the likelihood of onwards HIV transmission – known as ‘treatment as prevention’. It also delays the onset of AIDS-related illnesses, and morbidity and mortality in general. These findings were a result of the HPTN 052 study (completed in 2011), which showed that early initiation of treatment has both health and prevention benefits.
The WHO 2013 guidelines also have recommendations for if there are complications. They say ARV treatment should be initiated immediately regardless of CD4 count for patients who are: pregnant orbreastfeeding, have active tuberculosis (TB), have severe and chronic HBV liver disease, are HIV-positive in a serodiscordant relationship, or a child under 5 years of age.