Treatment training manual

3. 7 When to start HIV treatment (ART)

ART is now recommended soon after diagnosis, for all people living with HIV.

This is at any CD4 count, even when the CD4 count is strong and above 500.

This is based on important studies (including START and TEMPRANO). It is also related to other studies showing that ART can stop HIV transmission. See: Undetectable = Untransmittable (U=U).

In 2015, START showed that HIV can still cause serious problems at a high CD4 count. And that ART reduces these risks.

However, a few countries still restrict ART to people with a CD4 count below 500. This is usually for financial reasons, if access to ART is limited.

  • Guidelines also say that someone has to be ready to start ART.
  • HIV-related symptoms shows a greater urgency to start ART.
  • Everyone is strongly recommended to start before their CD4 count falls to below 350 cells/mm3. This is with or without any symptoms.

Being ready to start ART involves understanding the following general points.

  • Treatment will help your health.
  • ART doesn’t work unless you take it.
  • Good adherence is linked to the best results.
  • Adherence means following any food recommendations.
  • Side effects will usually be mild and can be managed.

These non-medical aspects are very important:

  • Someone has to be committed to ART before they start.
  • If adherence is not good, then resistance will develop and treatment can fail.

See Section 1.13 — Use of CD4 count to start treatment

Last updated: 1 January 2023.