Question

How long will my wife need to take ARVs?

14 February 2012. Related: Adherence, All topics, Pregnancy, Resistance.

Hi doctor.
I tested HIV positive 3 yrs ago together with my wife. I took septrin for 2months before I stopped. From the onset I took CD4 count and it was 465; the 2nd was 543; the 3rd was 650; the 4th was 770; the 5th was 861 and the last one I took two weeks ago was 940. The same case my wife who now has 897 up from 360.

She is on ARVS because we are trying to concieve. My question is, what are the risks of my wife stopping taking the ARVS? Or for how long will she take the Arvs?

We have not been using any protection. What are the risks?

Answer

Answer: Angelina Namiba

Firstly, I would like to confirm that we are HIV positive treatment advocates, and not doctors.

You have asked a number of questions so I will try and answer them one a time.

Your first question is what the risk to your wife if she stops taking her ARVs. Without treatment your wife’s CD4 count is likely to drop back to where it was before she started and to continue dropping. If her CD4 count drops to 200 cells or less, she may be at risk of developing opportunistic infections. These are infections such as pneumonia, which a person can get when they have a weak immune system.

Your second question is how long she will need to take the ARVs. Both European and WHO (World Health Organisation) treatment guidelines recommend starting when you have a CD4 count of 350. This is close to what your wife’s CD4 count was when she started. The aim of treatment is to maintain a good CD4 count (above 350) and to reduce the amount of virus in your body. This is referred to as having an undetectable viral load. Your wife will therefore need to continue taking the treatment for life. Having a good CD4 count and an undetectable viral load will enable her to stay well for many years.

Your third question was regarding what the risks are if you don’t use protection as you are trying to conceive. Many HIV positive choose not to use condoms for protection. The main risk involved is if one of you has resistance to 1 or more HIV treatments. This is another reason why your wife should not stop taking ARVs. She will therefore need to take her medication exactly as advised and not miss any doses. This is to prevent her from becoming resistant to her current medication and risk passing on the resistance on to you. For more information on resistance, please follow this link to our guide.

Another risk of not using condoms is getting STIs [Sexually transmitted infections]. A further issue could be being re-infected with another strain of HIV. The HIV which one person has is not always the same type(strain) as another person. However, without knowing the full details around your circumstances, it is not possible to know if this will be an issue for you.

Generally, if neither of you have resistance or STIs, then there should be not problem with having unprotected sex. The key thing to note though is that if your wife does become pregnant, the recommendation is to use condoms. This is in order to minimise the risk of transmitting HIV to the baby. For more information on HIV, pregnancy and women’s health please follow this link to our guide

Best wishes