When should I start treatment?
HIV treatment (ART) is now routinely recommended for all HIV positive people.
But exactly when to start is an individual decision.
How quickly you need to start depends on many factors. These include:
- How long you are likely to have been HIV positive.
- Your current CD4 count and viral load.
- Whether you have other infections.
- Whether you are likely to need special support to take meds.
- Whether you are pregnant.
- Treatment guidelines in your country.
As long as there is not a medical urgency (such as pregnancy or a very low CD4), it is okay to take time to decide. If you were recently infected, this might be a reason to start ART more quickly.
You are the person who has to take the meds. You have a choice over when to start and the drugs you use.
Discuss this with your doctor before you need treatment.
- Ask about the different drugs. You need to know the good and bad things about each of them.
- Take time to think about what you want to do. Do not feel rushed or pressurised into doing something you don’t understand.
- If you have just been diagnosed, you may want time to think about this before you feel ready to start treatment. Unless your CD4 count is very low this should usually be ok.
UK guidelines recommend that anybody who is HIV positive can start ART. There are similar recommendations in the US and in WHO guidelines.
A few countries still recommend waiting until the CD4 count is less than 500.
The i-Base Introduction to ART guide has more information about starting treatment.
This answer has been updated many times from an original question in November 2012.