{"id":12980,"date":"2025-01-01T12:00:14","date_gmt":"2025-01-01T12:00:14","guid":{"rendered":"http:\/\/i-base.info\/guides\/?page_id=12980"},"modified":"2025-07-31T11:06:13","modified_gmt":"2025-07-31T11:06:13","slug":"iv-after-starting-art-in-detail","status":"publish","type":"page","link":"https:\/\/i-base.info\/guides\/art-in-pictures\/iv-after-starting-art-in-detail","title":{"rendered":"HIV after starting ART in detail"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-12959\" src=\"https:\/\/i-base.info\/guides\/wp-content\/uploads\/2017\/06\/johnwalter3-detail-3-197x300.png\" alt=\"\" width=\"197\" height=\"300\" srcset=\"https:\/\/i-base.info\/guides\/wp-content\/uploads\/2017\/06\/johnwalter3-detail-3-197x300.png 197w, https:\/\/i-base.info\/guides\/wp-content\/uploads\/2017\/06\/johnwalter3-detail-3-674x1024.png 674w, https:\/\/i-base.info\/guides\/wp-content\/uploads\/2017\/06\/johnwalter3-detail-3.png 1548w\" sizes=\"auto, (max-width: 197px) 100vw, 197px\" \/><\/p>\n<p><strong>ART begins to work within hours. This is much faster than most people realise. Viral load drops dramatically and quickly in three phases.<\/strong><\/p>\n<p><b>First phase \u2013 1 to 2 days:<\/b> During the first phase, ART blocks replication in short-lived CD4 cells that are actively infected. Because these cells only live for 1 to 2 days, viral load drops by 90% within a few days.<\/p>\n<p><b>Second phase \u2013 2 to 3 weeks:<\/b><b> <\/b>Over the next couple of weeks, viral load continues to drop, though slightly less steeply. After a few weeks viral load has usually dropped by 99% or more.<\/p>\n<p><b>Third phase \u2013 up to 12 weeks:<\/b> If viral load is still detectable after a month, it will continue to fall over the next few months, in the third phase. Most people reach undetectable within three months.<\/p>\n<p><b>The main aim of ART is to get viral load to below 50 copies\/mL. This is called undetectable.<\/b><\/p>\n<ul>\n<li>How quickly viral load drops will depend on the choice of drugs. Integrase inhibitors reduce viral load faster than other type of drugs.<\/li>\n<li>It also depends on how high viral load was before starting ART.<\/li>\n<li>Good adherence is essential. Meds can only work if they are taken as prescribed.<\/li>\n<\/ul>\n<p><b>Once viral load becomes undetectable, it can stay this low for years. with good adherence, this risk of drug resistance is very low.<\/b><\/p>\n<ul>\n<li>Although viral load tests do not measure below the 50 copy cut-off, viral load can go much lower. Many people get viral load to less than 5 copies\/mL and for some this is not detectable on tests measuring down to 1 copy\/mL.<\/li>\n<li>Compared to the 10 million copies\/mL in early infection, it is easy to see why ART stops HIV transmission.<\/li>\n<li>Becoming non-infectious on ART is another reason that many people start ART. <a href=\"https:\/\/i-base.info\/partner-study\/\">The PARTNER study<\/a> showed the dramatic impact of having an undetectable viral load. There were no linked HIV transmissions after couples had sex without condoms more than 100,000 times.<\/li>\n<\/ul>\n<h2>When to start ART<\/h2>\n<ul>\n<li>ART is now recommended for everyone who is HIV positive.<\/li>\n<li>This is even at high CD4 counts above 500..<\/li>\n<li>The decision to treat even at high CD4 counts\u00a0was due to <a href=\"https:\/\/i-base.info\/start\/\">the START study<\/a>.<\/li>\n<\/ul>\n<h2>Early treatment in the UK<\/h2>\n<ul>\n<li>UK treatment guidelines recommend treatment at any CD4 count.<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>All treatment guidelines recommend treatment at any CD4 count.<\/li>\n<li>This includes UK, EU, US and WHO guidelines.<\/li>\n<li>If your doctor says that your CD4 count is too high to need treatment, and you want to start ART, say that you want to reduce the risk to your partners.<\/li>\n<li>Many clinics now offer ART as soon as the HIV test is confirmed. Starting ART on the same day or week you are diagnosed is a choice that can make it easier to come to terms with living with HIV.<\/li>\n<\/ul>\n<h2>Same-day ART<\/h2>\n<ul>\n<li>Several studies have reported very positive results from offering ART when someone is diagnosed. This can be on the same day or in the same week.<\/li>\n<li>HIV is already being treated while coming to terms with being HIV positive.<\/li>\n<li>These studies had very high of uptake when people are given this choice. Rather than taking weeks or months of referrals and seeing specialists, ART is working immediately.<\/li>\n<li>Viral load became undetectable more quickly in these studies.<\/li>\n<\/ul>\n<h2>Long-term ART: summary<\/h2>\n<ul>\n<li>ART has dramatically changed the outcome for people living with HIV.<\/li>\n<li>More than 20 years of experience shows ART is effective and with low risk.<\/li>\n<li>Over this period, drugs have become better and research continues to improve ART. Even if no new drugs are developed, most of us will lead long and active lives.<\/li>\n<li>But scientists are pushing further \u2013 not just for better ART but for a cure. See\u00a0<a href=\"https:\/\/i-base.info\/guides\/art-in-pictures\/the-viral-reservoir\">HIV reservoir<\/a> and <a href=\"https:\/\/i-base.info\/guides\/art-in-pictures\/the-hiv-cure-puzzle\">cure research<\/a>.<\/li>\n<li>Longer life expectancy means that complications relating to HIV and ageing are now an important focus for research.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>ART begins to work within hours. This is much faster than most people realise. Viral load drops dramatically and quickly in three phases. First phase \u2013 1 to 2 days: During the first phase, ART blocks replication in short-lived CD4 &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":12837,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"page-guides.php","meta":{"footnotes":""},"class_list":["post-12980","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/12980","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/comments?post=12980"}],"version-history":[{"count":2,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/12980\/revisions"}],"predecessor-version":[{"id":18904,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/12980\/revisions\/18904"}],"up":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/12837"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/media?parent=12980"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}